Individual
ROBERT JAY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH.
Contact information
Practice address
4605 ENTERPRISE WAY STE 102, CALDWELL, ID 83605-6889
(208) 855-0701
Mailing address
675 BECK RD, NYSSA, OR 97913-5119
(208) 680-5786
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8202
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P8202
IDAHO PHARMACIST LICENSE
ID
Enumeration date
03/07/2019
Last updated
04/11/2024
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