Provider Demographics
NPI:1790879393
Name:AUER, JONATHAN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:M
Last Name:AUER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ST.JOHNS WAY
Mailing Address - Street 2:SUITE#2
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-746-6755
Mailing Address - Fax:208-746-6801
Practice Address - Street 1:312 ST.JOHNS WAY
Practice Address - Street 2:SUITE#2
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-746-6755
Practice Address - Fax:208-746-6801
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4668183500000X
WAPH00013580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist