NPI age
19 years
Enumerated 2007-05-25
Across 1739 active pharmacist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | P-4041 | STATE BOARD OF PHARMACY # |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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