Individual
SHANE ELLIS WITHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
164 E. MAIN, REXBURG, ID 83440
(208) 227-5076
Mailing address
4482 WEST 1000 NORTH, REXBURG, ID 83440
(208) 313-1736
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8493
ID
Other
Enumeration date
08/06/2019
Last updated
11/27/2023
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