Individual
ERICA MATAMOROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
911 N MAIN ST, POCATELLO, ID 83204-2831
(208) 478-8510
(208) 235-1328
Mailing address
911 N MAIN ST, POCATELLO, ID 83204-2831
(208) 478-8510
(208) 235-1328
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7610
ID
Other
Enumeration date
08/08/2016
Last updated
11/06/2020
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