Provider Demographics
NPI:1295855674
Name:BITTER, REBECCA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BITTER
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 1:1201 SOUTH 25TH STREET
Mailing Address - Street 2:PHARMACY
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406
Mailing Address - Country:US
Mailing Address - Phone:715-490-2612
Mailing Address - Fax:
Practice Address - Street 1:1201 S 25TH E
Practice Address - Street 2:PHARMACY
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-5729
Practice Address - Country:US
Practice Address - Phone:715-490-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050968183500000X
UT49989861701183500000X
WI16276040-40183500000X
IDP7303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist