Provider Demographics
NPI:1356718894
Name:MAINVIL-FISCHER, LINDA (PHARMD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAINVIL-FISCHER
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:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-1990
Mailing Address - Country:US
Mailing Address - Phone:208-493-2396
Mailing Address - Fax:
Practice Address - Street 1:805 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-493-2396
Practice Address - Fax:208-381-6340
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5348OtherIDAHO STATE BOARD OF PHARMACY