Individual
JACOB CROSSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1515 W STATE ST, BOISE, ID 83702-4039
(208) 345-7684
Mailing address
13186 S CATAWBA RIVER AVE, NAMPA, ID 83686-6836
(208) 252-1071
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8400
ID
Other
Enumeration date
10/07/2019
Last updated
08/24/2021
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