Individual
JAMES GLEN SOUTHWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM D.
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2738
Mailing address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2738
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7521
ID
Other
Enumeration date
12/25/2019
Last updated
12/25/2019
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