Individual
MASSARA K POLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
999 N CURTIS RD STE 102, BOISE, ID 83706-1331
(208) 367-2167
Mailing address
11858 W ALBANY DR, BOISE, ID 83713-2479
(619) 456-7173
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P10431
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P10431
BOARD OF PHARMACY
ID
Enumeration date
01/03/2023
Last updated
01/03/2023
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