Provider Demographics
NPI:1275774465
Name:CANTRELL, TONI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CARLILE DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4567
Mailing Address - Country:US
Mailing Address - Phone:208-705-7812
Mailing Address - Fax:
Practice Address - Street 1:4701 CARLILE DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4567
Practice Address - Country:US
Practice Address - Phone:208-705-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist