Provider Demographics
NPI:1558363283
Name:HOFSTETTER, MARK ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:HOFSTETTER
Suffix:
Gender:M
Credentials:PHARMD
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Mailing Address - Street 1:520 S EAGLE RD
Mailing Address - Street 2:SUITE 100 O/P PHARMACY
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6351
Mailing Address - Country:US
Mailing Address - Phone:208-706-5264
Mailing Address - Fax:208-706-5253
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:SUITE 100 O/P PHARMACY
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-5264
Practice Address - Fax:208-706-5253
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDP5307183500000X
WY2691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist