Healthcare Provider Details

I. General information

NPI: 1619803079
Provider Name (Legal Business Name): KIMBERLY MARIE WESTRICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W PRAIRIE AVE
HAYDEN ID
83835-8284
US

IV. Provider business mailing address

3291 W THORNDALE LOOP
COEUR D ALENE ID
83815-9735
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-7864
  • Fax:
Mailing address:
  • Phone: 208-755-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1281900
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: