Provider Demographics
NPI:1659852267
Name:LIERA, KELLY JONE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JONE
Last Name:LIERA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8425
Mailing Address - Country:US
Mailing Address - Phone:208-375-2825
Mailing Address - Fax:208-375-2846
Practice Address - Street 1:8100 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8425
Practice Address - Country:US
Practice Address - Phone:208-375-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCT37894183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician