Individual
KELLY LYNN HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD.
Contact information
Practice address
3499 E FAIRVIEW AVE, MERIDIAN, ID 83642-5848
(208) 884-1286
Mailing address
12376 W TEVOIT ST, BOISE, ID 83709-5372
(208) 308-5412
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6430
ID
Other
Enumeration date
07/11/2011
Last updated
10/11/2012
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