Individual
ANGELA DAWN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7402 W FAIRVIEW AVE, BOISE, ID 83704-8411
(208) 375-4670
Mailing address
7759 ELMORE RD, FRUITLAND, ID 83619-3528
(208) 740-9750
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9175
ID
Other
Enumeration date
01/02/2021
Last updated
01/02/2021
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