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General NPI Number Information
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NPI Number | 1295008969
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Entity Type | Individual
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Provider Name | KENNETH ROY INSELMAN R.PH
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Gender | Male
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 179 W HIGHWAY 52
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City | EMMETT
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State | ID
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Zip | 83617-9738
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Country | US
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Telephone | 208-272-9454
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Fax | 208-272-9460
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Provider Business Mailing Address
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Address Line | 179 W HIGHWAY 52
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City | EMMETT
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State | ID
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Zip | 83617-9738
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Country | US
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Telephone | 208-272-9454
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Fax | 208-272-9460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P3625
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | P3625
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License Number State | ID
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