Individual
DR. KYLE SHANE HOGABOAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
140 E MAIN ST, OTHELLO, WA 99344-1040
(509) 994-2142
Mailing address
140 EAST MAIN, OTHELLO, WA 99344
(509) 994-2142
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00040386
WA
Other
Enumeration date
03/20/2013
Last updated
03/20/2013
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