Basic Information
| Provider Information | |||||||||
| NPI: | 1174284525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | DARCY | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 S ROOSEVELT ST APT 18 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837054667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089926006 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5230 W FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837051109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084296433 | ||||||||
| FaxNumber: | 2084296427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2022 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | P9847 | ID | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.