Individual
DR. DUSTIN HANNAWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4110 S 10TH AVE, CALDWELL, ID 83605-5706
(208) 402-0154
Mailing address
4110 S 10TH AVE, CALDWELL, ID 83605-5706
(208) 402-0154
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9379
ID
Other
Enumeration date
07/08/2021
Last updated
07/08/2021
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