Individual
ETHAN TAN PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(208) 381-6161
Mailing address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(208) 381-6161
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3061173
ID
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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