Provider Demographics
NPI:1487336525
Name:LAMBERTSEN, FALLYN RAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FALLYN
Middle Name:RAY
Last Name:LAMBERTSEN
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 1:12000 S SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7840
Mailing Address - Country:US
Mailing Address - Phone:208-881-7872
Mailing Address - Fax:
Practice Address - Street 1:160 S CLARK ST
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1407
Practice Address - Country:US
Practice Address - Phone:208-745-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist