Individual
SPENCER LOUIS DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
3250 E 17TH ST, AMMON, ID 83406-6758
(208) 552-7677
Mailing address
3270 E 17TH ST # 130, AMMON, ID 83406-6758
(208) 569-5839
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5827
ID
Other
Enumeration date
02/12/2019
Last updated
02/12/2019
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