Individual
LYNETTE MIYASAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 2ND ST S, NAMPA, ID 83651-3700
(208) 465-2836
(208) 465-2833
Mailing address
705 WILLOW FALLS CT, CALDWELL, ID 83605-5892
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5408
ID
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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