NPI 1033329248

Travis Anthony Park, PHARMD

Practitioner Pharmacist Coeur D Alene, ID

Practice location

Address: 2003 Lincoln Way, Coeur D Alene, ID 83814-2611
Phone: (208) 666-3032
Mailing address: 3316 E Pine Hill Dr, Coeur D Alene, ID 83815-6618

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence P6016 (ID)

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Registry record

NPI: 1033329248
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 May 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.