Healthcare Provider Details

I. General information

NPI: 1629456926
Provider Name (Legal Business Name): K2RED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S VISTA AVE
BOISE ID
83705-2424
US

IV. Provider business mailing address

801 S VISTA AVE
BOISE ID
83705-2424
US

V. Phone/Fax

Practice location:
  • Phone: 208-364-7777
  • Fax: 208-364-7778
Mailing address:
  • Phone: 208-364-7777
  • Fax: 208-364-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL S FUCHS
Title or Position: MEMBER/RPH
Credential: RPH
Phone: 208-364-7777