Individual
SHANE OLIVER WITHERS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, BCPS
Contact information
Practice address
2495 E LINCOLN RD, IDAHO FALLS, ID 83401-2203
(986) 497-3149
Mailing address
933 E ELVA ST, IDAHO FALLS, ID 83401-2164
(208) 313-4336
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8466
ID
Other
Enumeration date
09/29/2019
Last updated
04/10/2022
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