Individual
MASON GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
714 N COLLEGE RD STE A, TWIN FALLS, ID 83301-5812
(208) 420-0674
Mailing address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-2500
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8032
ID
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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