Individual
KEN DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 E FAIRVIEW AVE, MERIDIAN, ID 83642-1732
(208) 888-4414
Mailing address
4582 W GILLETTE ST, MERIDIAN, ID 83642-4278
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
—
—
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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