Provider Demographics
NPI:1326335746
Name:JOFFER, RAYMOND (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:JOFFER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4426
Mailing Address - Country:US
Mailing Address - Phone:208-454-0484
Mailing Address - Fax:208-454-3115
Practice Address - Street 1:2500 BLAINE ST.
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4426
Practice Address - Country:US
Practice Address - Phone:208-454-0484
Practice Address - Fax:208-454-3115
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist