Individual
MR. NEIL TETSUO KOMODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2425 CHANNING WAY, IDAHO FALLS, ID 83404-8059
(208) 523-2277
(208) 552-1246
Mailing address
2425 CHANNING WAY, IDAHO FALLS, ID 83404-8059
(208) 523-2277
(208) 552-1246
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P3674
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
421CP
LICENSE
ID
Enumeration date
12/22/2006
Last updated
07/08/2007
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