Individual
JESSICA VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1611 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-3374
(208) 736-3321
Mailing address
1611 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-3374
(208) 736-3321
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7210
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P7210
BOARD OF PHARMACY LICENSE
ID
Enumeration date
07/15/2015
Last updated
07/15/2015
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