Individual
LESLIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4850 N LINDER RD, MERIDIAN, ID 83646-6159
(208) 319-0047
Mailing address
6727 W MORRIS HILL LN APT 101, APT 101, BOISE, ID 83704-9288
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6427
ID
Other
Enumeration date
10/10/2011
Last updated
10/29/2013
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