Individual
PETER MGONJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3527 S FEDERAL WAY, BOISE, ID 83705-5204
(208) 424-7533
(208) 424-7527
Mailing address
3527 S FEDERAL WAY, BOISE, ID 83705-5204
(208) 424-7533
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5935
ID
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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