Provider Demographics
NPI:1881985836
Name:LANCE, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 S COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2815
Mailing Address - Country:US
Mailing Address - Phone:208-323-8707
Mailing Address - Fax:208-327-9577
Practice Address - Street 1:2051 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2815
Practice Address - Country:US
Practice Address - Phone:208-323-8707
Practice Address - Fax:208-327-9577
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5811183500000X
NV15141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist