Healthcare Provider Details

I. General information

NPI: 1043679020
Provider Name (Legal Business Name): KATHLEEN MARTINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W CHINDEN BLVD
MERIDIAN ID
83646-5328
US

IV. Provider business mailing address

1400 W CHINDEN BLVD
MERIDIAN ID
83646-5328
US

V. Phone/Fax

Practice location:
  • Phone: 208-893-6033
  • Fax: 208-893-6027
Mailing address:
  • Phone: 208-893-6033
  • Fax: 208-893-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP-10690
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: