Individual
KELLI NYBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
700 E AVALON ST, KUNA, ID 83634-2140
(208) 922-9836
Mailing address
700 E AVALON ST, KUNA, ID 83634-2140
(208) 922-9836
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6028
ID
Other
Enumeration date
09/16/2016
Last updated
09/16/2016
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