Individual
AMANDA SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
10580 W USTICK RD, STORE #5184, BOISE, ID 83704-5267
(208) 377-3581
Mailing address
10580 W USTICK RD, STORE #5184, BOISE, ID 83704-5267
(208) 377-3581
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
CS36244
ID
183500000X
Pharmacist
I059211-1
NY
183500000X
Pharmacist
Primary
P7083
ID
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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