Provider Demographics
NPI:1508065814
Name:FELDTMAN, MICHELLE M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:FELDTMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1122
Mailing Address - Country:US
Mailing Address - Phone:208-319-2312
Mailing Address - Fax:208-319-2316
Practice Address - Street 1:3150 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1122
Practice Address - Country:US
Practice Address - Phone:208-319-2312
Practice Address - Fax:208-319-2316
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP4984OtherSTATE BOARD OF PHARMACY