Individual
TAN NATHAN LUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1603 12TH AVE RD, NAMPA, ID 83686-7712
(208) 465-7000
Mailing address
1603 12TH AVE RD, NAMPA, ID 83686-7712
(208) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5384
ID
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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