Individual
MR. SEBASTIAN NED GREGORIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2163 S ILLINOIS AVE, BOISE, ID 83706-4218
(208) 724-8937
(210) 757-7820
Mailing address
2163 S ILLINOIS AVE, BOISE, ID 83706-4218
(208) 724-8937
(210) 757-7820
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0011562
OR
183500000X
Pharmacist
P4856
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011562
PHARMACIST LICENSE
OR
01
—
P4856
PHARMACIST LICENSE
ID
Enumeration date
08/06/2015
Last updated
08/06/2015
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