Individual
LARRY LAMAR ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
10 S MAIN ST, DRIGGS, ID 83422-9700
(208) 354-2334
Mailing address
65 E HOWARD ST, DRIGGS, ID 83422-5147
(208) 354-3035
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6051
ID
Other
Enumeration date
10/08/2008
Last updated
10/08/2008
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