Individual
KELLY DIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2327 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 535-4795
Mailing address
1186 N 1325 E, SHELLEY, ID 83274-5328
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6694
ID
Other
Enumeration date
06/11/2020
Last updated
06/11/2020
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