Individual
GARRET PORTELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 N STATE ST, RIGBY, ID 83442-1443
(208) 745-0267
Mailing address
1547 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4284
(208) 351-7284
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0014200
OR
Other
Enumeration date
05/28/2014
Last updated
08/31/2016
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