Individual
GARY ALFRED DEBLAQUIERE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1222 ALBENI HWY, PRIEST RIVER, ID 83856-9393
(208) 448-1633
(208) 448-1728
Mailing address
PO BOX 458, PRIEST RIVER, ID 83856-0458
(208) 448-1633
(208) 448-1728
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4094
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P4094
PHARMACY LIC
ID
Enumeration date
10/05/2005
Last updated
07/08/2007
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