Individual
BLAKE SOMMERS NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1611 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-3374
(208) 736-3321
Mailing address
550 W IDAHO ST, ELKO, NV 89801-2976
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8325
ID
Other
Enumeration date
04/12/2019
Last updated
04/12/2019
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