Individual
DR. KENNETH DIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD,MBA
Contact information
Practice address
1219 BROADWAY AVE, BOISE, ID 83706-3701
(208) 433-9905
(208) 433-9907
Mailing address
4636 E NARCISSUS CT, BOISE, ID 83716-7002
(208) 433-8721
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5175
ID
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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