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General NPI Number Information
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NPI Number | 1528444197
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Entity Type | Individual
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Provider Name | SEBASTIAN NED GREGORIO RPH
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Gender | Male
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2163 S ILLINOIS AVE
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City | BOISE
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State | ID
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Zip | 83706-4218
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Country | US
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Telephone | 208-724-8937
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Fax | 210-757-7820
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Provider Business Mailing Address
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Address Line | 2163 S ILLINOIS AVE
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City | BOISE
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State | ID
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Zip | 83706-4218
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Country | US
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Telephone | 208-724-8937
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Fax | 210-757-7820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0011562
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P4856
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License Number State | ID
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