NPI 1699177527

Jeffrey Koudelka, PHARMD

Practitioner Pharmacist Gooding, ID

Practice location

Address: 1427 Main St, Gooding, ID 83330-1838
Phone: (208) 934-4709
Fax: (208) 934-4905

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence P5033 (ID)

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Registry record

NPI: 1699177527
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Sep 2014
Record last updated: 23 Sep 2014

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.