Provider Demographics
NPI:1316216773
Name:BIDDLE, MICHAEL ALFRED JR (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALFRED
Last Name:BIDDLE
Suffix:JR
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
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Mailing Address - Street 1:4830 W GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3623
Mailing Address - Country:US
Mailing Address - Phone:304-638-6994
Mailing Address - Fax:802-654-0716
Practice Address - Street 1:1000 E PARK BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7791
Practice Address - Country:US
Practice Address - Phone:208-381-4100
Practice Address - Fax:208-381-4101
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist