Individual
MRS. SALLY ANN EKE HAGESTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
34987 JACKS CANYON RD, LENORE, ID 83541-6264
(208) 816-6770
Mailing address
34987 JACKS CANYON RD, LENORE, ID 83541-6264
(208) 816-6770
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6090
ID
Other
Enumeration date
12/27/2013
Last updated
12/27/2013
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