Individual
LEILI IZADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S UTAH AVE, IDAHO FALLS, ID 83402
(208) 552-6169
(205) 528-8695
Mailing address
405 NAPA DR, IDAHO FALLS, ID 83404-7681
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6680
ID
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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