Individual
DEAN A WALLENTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D.
Contact information
Practice address
836 WASHINGTON ST, MONTPELIER, ID 83254-1423
(208) 847-1421
(208) 847-1690
Mailing address
836 WASHINGTON ST, MONTPELIER, ID 83254-1423
(208) 847-1421
(208) 847-1690
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5441
ID
332B00000X
Durable Medical Equipment & Medical Supplies
P5441
ID
3336C0003X
Community/Retail Pharmacy
1440CP
ID
Other
Enumeration date
08/23/2005
Last updated
04/13/2015
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