Individual
HEATHER SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 W STATE ST, BOISE, ID 83702-4039
(208) 345-7684
Mailing address
11612 W ALFRED CT, BOISE, ID 83713-1893
(208) 850-9116
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P9131
ID
Other
Enumeration date
01/13/2021
Last updated
01/13/2021
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