NPI age
13 years
Enumerated 2013-04-11
Across 1739 active pharmacist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | P5801 | IDAHO PHARMACIST LICENSE |
| 01 (WA) | PH 00055425 | WASHINGTON PHARMACIST LICENSE |
| 01 (ID) | CS10374 | PHARMACIST CONTROLLED SUBSTANCE LICENSE |
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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