Individual
THOMAS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
1515 W STATE ST, BOISE, ID 83702-4039
(208) 345-7684
Mailing address
19621 10TH DR SE, BOTHELL, WA 98012-7765
(425) 381-7164
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9854
ID
Other
Enumeration date
02/03/2022
Last updated
02/03/2022
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