Provider Demographics
NPI:1336314921
Name:EGGLESTON, ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3627
Mailing Address - Country:US
Mailing Address - Phone:208-459-1756
Mailing Address - Fax:208-459-8506
Practice Address - Street 1:415 CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3627
Practice Address - Country:US
Practice Address - Phone:208-459-1756
Practice Address - Fax:208-459-8506
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist