Individual
TERRY A NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
7670 FAIRVIEW AVE, BOISE, ID 83704-8415
(208) 376-0053
(208) 376-4759
Mailing address
7670 FAIRVIEW AVE, BOISE, ID 83704-8415
(208) 376-0053
(208) 376-4759
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4019
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P4019
183500000X
ID
Enumeration date
05/18/2009
Last updated
05/18/2009
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