Provider Demographics
NPI:1215219274
Name:WOODBURN, JANET (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16329 BEET RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-9371
Mailing Address - Country:US
Mailing Address - Phone:208-459-1246
Mailing Address - Fax:
Practice Address - Street 1:20 EAST WYOMING
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-337-4888
Practice Address - Fax:208-337-4898
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4366183500000X
AZS017443183500000X
WAPH00011129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist