Provider Demographics
NPI:1568578730
Name:EGBERT, FRANK GERALD (PHARM D)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:GERALD
Last Name:EGBERT
Suffix:
Gender:M
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 1:3185 AMHERST CIR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8319
Mailing Address - Country:US
Mailing Address - Phone:208-524-9113
Mailing Address - Fax:
Practice Address - Street 1:3185 AMHERST CIR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8319
Practice Address - Country:US
Practice Address - Phone:208-524-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist