Individual
NICOLE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3263 N EAGLE RD, MERIDIAN, ID 83646-5702
(208) 319-0612
Mailing address
3800 W PERUGIA ST APT H204, MERIDIAN, ID 83642-4981
(909) 654-8310
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9165
ID
Other
Enumeration date
01/09/2021
Last updated
01/09/2021
About Stedi
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