Provider Demographics
NPI:1740890094
Name:HEUN, EMILIE (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:HEUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 W USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5103
Mailing Address - Country:US
Mailing Address - Phone:208-322-7788
Mailing Address - Fax:
Practice Address - Street 1:10700 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5103
Practice Address - Country:US
Practice Address - Phone:208-322-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist