Provider Demographics
NPI:1518238245
Name:TOLLINGER, ALBERT STANTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:STANTON
Last Name:TOLLINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1003
Mailing Address - Country:US
Mailing Address - Phone:208-323-6089
Mailing Address - Fax:
Practice Address - Street 1:16700 N MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7909
Practice Address - Country:US
Practice Address - Phone:208-465-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist