Individual
TRACY LYNN BIDEGANETA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
270 N 2ND E, MOUNTAIN HOME, ID 83647-2725
(208) 587-3346
(208) 587-2052
Mailing address
270 N 2ND E, MOUNTAIN HOME, ID 83647-2725
(208) 587-2368
(208) 587-2052
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4566
ID
Other
Enumeration date
11/22/2005
Last updated
07/08/2007
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