Individual
NATHAN BOLANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
570 S STATE ST, SHELLEY, ID 83274-1470
(208) 357-0473
Mailing address
570 S STATE ST, SHELLEY, ID 83274-1470
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7270
ID
Other
Enumeration date
06/23/2015
Last updated
09/26/2016
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