Healthcare Provider Details

I. General information

NPI: 1427895952
Provider Name (Legal Business Name): KIMBERLY MCGILLIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 W AIRPORT WAY # 700
BOISE ID
83705-5168
US

IV. Provider business mailing address

2141 W AIRPORT WAY # 700
BOISE ID
83705-5168
US

V. Phone/Fax

Practice location:
  • Phone: 844-515-2400
  • Fax: 877-627-6093
Mailing address:
  • Phone: 844-515-2400
  • Fax: 877-627-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1861961
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: