Provider Demographics
NPI:1922873207
Name:WAHNSCHAFFE, JADE ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:ANNE
Last Name:WAHNSCHAFFE
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 1:8300 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1639
Mailing Address - Country:US
Mailing Address - Phone:208-321-9080
Mailing Address - Fax:
Practice Address - Street 1:8300 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1639
Practice Address - Country:US
Practice Address - Phone:208-321-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist