Individual
TRAVIS WALTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
173 W 4TH ST, KUNA, ID 83634-2046
(208) 922-4400
(208) 922-4499
Mailing address
173 W 4TH ST, PO BOX 246, KUNA, ID 83634-2046
(208) 922-4400
(208) 922-4499
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5435
ID
Other
Enumeration date
12/28/2012
Last updated
12/28/2012
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