Individual
NADIA PHOUPHOMMAKHITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1914 8TH ST, CORALVILLE, IA 52241-1612
(319) 351-3880
Mailing address
2273 EVERSULL LN, NORTH LIBERTY, IA 52317-8085
(815) 980-9001
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
24862
IA
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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