Individual
SAMANTHA JANE MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 12TH AVE S, NAMPA, ID 83651-4255
(208) 467-1560
Mailing address
1419 N OHIO AVE, CALDWELL, ID 83605-2115
(208) 989-0183
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CT46828
ID
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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