Provider Demographics
NPI:1700228822
Name:DION, BRENT MICHEAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:MICHEAL
Last Name:DION
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 W SELWAY RAPIDS LN APT 208
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6201
Mailing Address - Country:US
Mailing Address - Phone:406-939-1603
Mailing Address - Fax:
Practice Address - Street 1:700 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4255
Practice Address - Country:US
Practice Address - Phone:208-467-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist