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General NPI Number Information
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NPI Number | 1922720515
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Entity Type | Individual
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Provider Name | DYLAN MEYERSON
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Gender | Male
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1320 S BLAINE ST
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City | MOSCOW
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State | ID
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Zip | 83843-3971
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Country | US
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Telephone | 208-883-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 501 NW IRVING ST
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City | PULLMAN
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State | WA
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Zip | 99163-3052
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Country | US
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Telephone | 713-320-9739
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Fax |
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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 | P10242
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License Number State | ID
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