Provider Demographics
NPI:1760717672
Name:MIDDLETON, ALBERT PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PAUL
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MAIN STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341
Mailing Address - Country:US
Mailing Address - Phone:208-423-4248
Mailing Address - Fax:208-423-5767
Practice Address - Street 1:210 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-0000
Practice Address - Country:US
Practice Address - Phone:208-423-4248
Practice Address - Fax:208-423-5767
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-4911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist