Individual
SANDY DERVISEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8300 W OVERLAND RD, BOISE, ID 83709-1639
(208) 321-9080
Mailing address
6082 S TALLOWTREE WAY, BOISE, ID 83716-6966
(208) 598-2925
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P10821
ID
Other
Enumeration date
08/11/2023
Last updated
08/11/2023
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