Individual
CHAX BRANDON PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
8093 N CORNERSTONE DR, HAYDEN, ID 83835-8753
(208) 762-9355
(208) 762-9198
Mailing address
16654 N MORGAN LN, HAYDEN, ID 83835-5015
(208) 651-6195
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5271
ID
Other
Enumeration date
03/06/2014
Last updated
03/06/2014
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