Provider Demographics
NPI:1609871474
Name:FLOWERS, WADE H JR (PHARMD, BCPS, CGP)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:H
Last Name:FLOWERS
Suffix:JR
Gender:M
Credentials:PHARMD, BCPS, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13103 W RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5129
Mailing Address - Country:US
Mailing Address - Phone:208-238-1281
Mailing Address - Fax:208-782-3709
Practice Address - Street 1:98 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1758
Practice Address - Country:US
Practice Address - Phone:208-782-3770
Practice Address - Fax:208-782-3709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP46561835P1200X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1381OtherCGP
ID3 08 010444OtherBCPS