Provider Demographics
NPI:1013127109
Name:OLIPHANT, CATHERINE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:OLIPHANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1230 N MACAILE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6920
Mailing Address - Country:US
Mailing Address - Phone:208-381-4146
Mailing Address - Fax:208-381-1665
Practice Address - Street 1:300 E JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6246
Practice Address - Country:US
Practice Address - Phone:208-381-4146
Practice Address - Fax:208-381-1665
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP57241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy