Individual
SAMUEL WEATHERSPOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
795 W OVERLAND RD, MERIDIAN, ID 83642-6556
(208) 917-6902
Mailing address
484 W PECK ST, MERIDIAN, ID 83646-5918
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7096
ID
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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