Individual
CASEY HUMPHERYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
836 WASHINGTON ST, MONTPELIER, ID 83254-1423
(208) 847-1421
Mailing address
836 WASHINGTON ST, MONTPELIER, ID 83254-1423
(208) 847-1421
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6688
ID
Other
Enumeration date
08/09/2012
Last updated
02/25/2015
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