Provider Demographics
NPI:1457673741
Name:PROUDFOOT, MICHAEL RIXFORD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RIXFORD
Last Name:PROUDFOOT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 N BOGART LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-4302
Mailing Address - Country:US
Mailing Address - Phone:281-253-6265
Mailing Address - Fax:
Practice Address - Street 1:1813 CALDWELL BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1505
Practice Address - Country:US
Practice Address - Phone:208-466-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist