Individual
MRS. MELISSA ANN HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4215 YELLOWSTONE AVE, CHUBBUCK, ID 83202-2419
(208) 237-6828
Mailing address
4415 ZIEBARTH ROAD, POCATELLO, ID 83204
(208) 241-6912
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4850
ID
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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