Individual
MATTHEW BOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 S PLUMMER RD, STAR, ID 83669-6199
(208) 286-0906
Mailing address
11714 W SILVER CITY ST, BOISE, ID 83713-7859
(208) 473-8835
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P11047
ID
Other
Enumeration date
12/27/2024
Last updated
12/27/2024
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