Individual
CASEY HAYCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
10500 W OVERLAND RD, BOISE, ID 83709-1435
(208) 376-4101
Mailing address
10500 W OVERLAND RD, BOISE, ID 83709-1435
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT20939
ID
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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