Individual
MRS. KIMBERLY DAWN PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
212 BONNER MALL WAY, PONDERAY, ID 83852-9748
(208) 255-8066
(208) 263-6623
Mailing address
212 BONNER MALL WAY, PONDERAY, ID 83852-9748
(208) 255-8066
(208) 263-6623
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5173
ID
Other
Enumeration date
08/22/2013
Last updated
08/22/2013
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