Healthcare Provider Details

I. General information

NPI: 1699257014
Provider Name (Legal Business Name): KASEY HARWICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W FAIRVIEW AVE
BOISE ID
83704-8425
US

IV. Provider business mailing address

8100 W FAIRVIEW AVE
BOISE ID
83704-8425
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-2825
  • Fax: 208-375-2846
Mailing address:
  • Phone: 208-375-2825
  • Fax: 208-375-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCT38764
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: