Individual
BRADLEY MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
10700 USTICK RD, BOISE, ID 83713-5103
(208) 322-7788
Mailing address
8480 W STONEHAVEN ST, BOISE, ID 83704-7078
(208) 867-2127
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8079
ID
Other
Enumeration date
07/20/2018
Last updated
07/20/2018
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