Provider Demographics
NPI:1467071811
Name:HOWARTH, CASSIDY PAIGE
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:PAIGE
Last Name:HOWARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5861 VICTOR MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-5482
Mailing Address - Country:US
Mailing Address - Phone:208-201-9728
Mailing Address - Fax:
Practice Address - Street 1:5861 VICTOR MEADOWS DR
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:ID
Practice Address - Zip Code:83455-5482
Practice Address - Country:US
Practice Address - Phone:208-201-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDE42512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist