Provider Demographics
NPI:1376839290
Name:PATTERSON, PATRICIA ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:PATTERSON
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 1:10580 W USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5267
Mailing Address - Country:US
Mailing Address - Phone:208-377-3581
Mailing Address - Fax:208-377-4165
Practice Address - Street 1:10580 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5267
Practice Address - Country:US
Practice Address - Phone:208-377-3581
Practice Address - Fax:208-377-4165
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist