Individual
GREGORY NELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
253 E 650 N, JEROME, ID 83338-5035
(623) 687-1562
Mailing address
253 E 650 N, JEROME, ID 83338-5035
(623) 687-1562
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
P-001165
OR
183500000X
Pharmacist
Primary
P6278
ID
Other
Enumeration date
08/05/2009
Last updated
08/05/2009
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