Provider Demographics
NPI:1831684018
Name:WEBSTER-DODGE, JANENE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:JANENE
Middle Name:MARIE
Last Name:WEBSTER-DODGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 N HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2327
Mailing Address - Country:US
Mailing Address - Phone:208-995-3778
Mailing Address - Fax:
Practice Address - Street 1:9732 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5766
Practice Address - Country:US
Practice Address - Phone:208-286-0906
Practice Address - Fax:208-286-0726
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist