Individual
NICHOLE LEANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
700 12TH AVE S, NAMPA, ID 83651-4255
(208) 467-1560
Mailing address
700 12TH AVE S, NAMPA, ID 83651-4255
(208) 467-1560
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT42115
ID
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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