Provider Demographics
NPI:1679910491
Name:BEUTLER, TRISHA M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:M
Last Name:BEUTLER
Suffix:
Gender:F
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 1:11809 SHALAKO RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5095
Mailing Address - Country:US
Mailing Address - Phone:208-251-8838
Mailing Address - Fax:
Practice Address - Street 1:11809 SHALAKO RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5095
Practice Address - Country:US
Practice Address - Phone:208-251-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6285183500000X
ORRPH-0012501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist