Individual
MADISON PURYEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
86 TANK RD, OLDTOWN, ID 83822-5126
(208) 457-7160
Mailing address
PO BOX 458, PRIEST RIVER, ID 83856-0458
(208) 448-1633
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P10739
ID
Other
Enumeration date
07/17/2023
Last updated
11/19/2024
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