Individual
CONNER PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
455 S BROADWAY AVE, BOISE, ID 83702-7643
(208) 331-4187
Mailing address
455 S BROADWAY AVE, BOISE, ID 83702-7643
(208) 331-4187
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7602
ID
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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