Individual
DR. ALLISON CLARK DEYETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
16700 N MARKET PLACE BLVD, NAMPA, ID 83687-7909
(208) 465-3809
(208) 465-3806
Mailing address
16700 N MARKET PLACE BLVD, NAMPA, ID 83687-7909
(208) 465-3809
(208) 465-3806
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5582
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P5582
IDAHO STATE BOARD OF PHARMACY
ID
Enumeration date
04/22/2011
Last updated
04/22/2011
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