Provider Demographics
NPI:1265762223
Name:PREISS, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:PREISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W HONEYSUCKLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9270
Mailing Address - Country:US
Mailing Address - Phone:208-762-0185
Mailing Address - Fax:208-772-0327
Practice Address - Street 1:260 W HONEYSUCKLE AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9270
Practice Address - Country:US
Practice Address - Phone:208-762-0185
Practice Address - Fax:208-772-0327
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5397183500000X
IDP6109183500000X
MT6149183500000X
WAPH60018657183500000X
WI14393-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist