Provider Demographics
NPI:1659870913
Name:WEST, MALYSSA ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MALYSSA
Middle Name:ROSE
Last Name:WEST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8306
Mailing Address - Country:US
Mailing Address - Phone:208-323-0067
Mailing Address - Fax:208-323-5954
Practice Address - Street 1:8455 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8306
Practice Address - Country:US
Practice Address - Phone:208-323-0067
Practice Address - Fax:208-323-5954
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist