Provider Demographics
NPI:1467737767
Name:PELAZINI, RICO LYNN (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:RICO
Middle Name:LYNN
Last Name:PELAZINI
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1926
Mailing Address - Country:US
Mailing Address - Phone:208-319-1271
Mailing Address - Fax:208-319-1274
Practice Address - Street 1:6725 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1926
Practice Address - Country:US
Practice Address - Phone:208-319-1271
Practice Address - Fax:208-319-1274
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist