Individual
TOMMY JOE GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1815 21ST ST, LEWISTON, ID 83501-4103
(208) 746-0579
(208) 746-0685
Mailing address
1815 21ST ST, LEWISTON, ID 83501-4103
(208) 746-0579
(208) 746-0685
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4833
ID
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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