Individual
NICKOLAS DAVID WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1649 POLE LINE RD E, TWIN FALLS, ID 83301-8397
(208) 734-3791
(208) 736-7476
Mailing address
1649 POLE LINE RD E, TWIN FALLS, ID 83301-8397
(208) 734-3791
(208) 736-7476
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8038
ID
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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