Provider Demographics
NPI:1770173304
Name:BIELER, AUDREY ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ANNE
Last Name:BIELER
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 1:705 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-2334
Mailing Address - Country:US
Mailing Address - Phone:208-315-5737
Mailing Address - Fax:
Practice Address - Street 1:1904 19TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4069
Practice Address - Country:US
Practice Address - Phone:208-743-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist