Individual
RYAN GORDON DAWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2493
Mailing address
12056 W FOXHAVEN ST, STAR, ID 83669-5953
(801) 318-0921
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7803
ID
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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