Individual
JACOB TIMOTHY VANVLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
427 N 12TH STREET, PLUMMER, ID 83851-0388
(208) 685-1931
(208) 685-5511
Mailing address
PO BOX 388, 427 N 12TH STREET, PLUMMER, ID 83851-0388
(208) 685-1931
(208) 685-5511
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6000
ID
Other
Enumeration date
08/24/2006
Last updated
03/15/2019
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