Provider Demographics
NPI:1457858482
Name:VONWAHLDE, HANNAH MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:VONWAHLDE
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 1:700 W IRONWOOD DR STE 228
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4473
Mailing Address - Country:US
Mailing Address - Phone:208-625-5672
Mailing Address - Fax:208-625-6488
Practice Address - Street 1:700 W IRONWOOD DR STE 228
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4473
Practice Address - Country:US
Practice Address - Phone:208-625-5672
Practice Address - Fax:208-625-6488
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60657095183500000X
IDP8985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist