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General NPI Number Information
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NPI Number | 1316031412
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Entity Type | Organization
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Legal Business Name | K2RED L.L.C.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 630 ADDISON AVE W STE 120
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City | TWIN FALLS
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State | ID
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Zip | 83301-5475
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Country | US
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Telephone | 208-737-2620
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Fax | 208-737-2621
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Provider Business Mailing Address
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Address Line | 630 ADDISON AVE W STE 120
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City | TWIN FALLS
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State | ID
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Zip | 83301-5475
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Country | US
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Telephone | 208-737-2620
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Fax | 208-737-2621
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DANIEL SCOTT FUCHS
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Credential | RPH
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Telephone | 208-737-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1328CP
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License Number State | ID
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