Healthcare Provider Details

I. General information

NPI: 1083928832
Provider Name (Legal Business Name): K2RED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 BROADWAY AVE S
BUHL ID
83316-1310
US

IV. Provider business mailing address

419 BROADWAY AVE S
BUHL ID
83316
US

V. Phone/Fax

Practice location:
  • Phone: 208-543-5353
  • Fax: 208-543-2202
Mailing address:
  • Phone: 208-543-5353
  • Fax: 208-543-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14706RP
License Number StateID

VIII. Authorized Official

Name: DAN FUCHS
Title or Position: MEMBER
Credential:
Phone: 208-543-5353