Individual
ELIA SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 W STATE ST, BOISE, ID 83702-4039
(208) 345-7684
Mailing address
1515 W STATE ST, BOISE, ID 83702-4039
(208) 345-7684
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT67210
ID
Other
Enumeration date
03/08/2023
Last updated
03/08/2023
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