Individual
JESSE SUE WAGEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
4845 YELLOWSTONE AVE, CHUBBUCK, ID 83202-2333
(208) 237-3900
Mailing address
1201 EAST GILBERT AVE, COEUR D ALENE, ID 83815-2333
(208) 916-6879
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E3950
ID
Other
Enumeration date
06/17/2011
Last updated
11/10/2014
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