Individual
DALLISA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT-ADV
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843-3046
(208) 883-6245
Mailing address
517 ELM ST # 194, TROY, ID 83871-0077
(208) 596-5223
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT1222
ID
Other
Enumeration date
07/03/2026
Last updated
07/03/2026
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