Individual
MIKAYLA CORNWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9898
ID
183500000X
Pharmacist
PH61063607
WA
Other
Enumeration date
12/17/2020
Last updated
08/21/2024
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