Individual
KAYLA WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2327 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 528-1000
Mailing address
3381 JUDY ST, AMMON, ID 83406-7549
(208) 681-5741
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P10352
ID
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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