Individual
FRED M OTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5425 W CHINDEN BLVD, GARDEN CITY, ID 83714-1468
(208) 323-7036
Mailing address
10789 W DASON CT, BOISE, ID 83713-1850
(208) 375-1486
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
CS2026
ID
183500000X
Pharmacist
Primary
P4096
ID
Other
Enumeration date
04/04/2011
Last updated
04/04/2011
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