Individual
KENNETH RICHARD STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
10555 W OVERLAND RD, BOISE, ID 83709-1436
(208) 321-2669
Mailing address
10555 W OVERLAND RD, BOISE, ID 83709-1436
(208) 321-2669
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
6035703-1701
UT
183500000X
Pharmacist
6035703-8911
UT
183500000X
Pharmacist
CS18944
ID
183500000X
Pharmacist
Primary
P6643
ID
183500000X
Pharmacist
S019112
AZ
Other
Enumeration date
03/28/2013
Last updated
03/28/2013
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