Kalin Joseph Craynor
Individual provider Active NPI Pharmacist · Idaho Falls, ID
NPI 1003597345 · NPPES record last updated Jul 28, 2023
Key facts
- NPI
- 1003597345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P10808 (ID)
- Practice address
- 535 E 17TH St
Idaho Falls, ID 83404-6154 - Phone
- (208) 542-4569
- NPI assigned
- Jul 28, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10808 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P10808 | ID | Yes |
Addresses
Primary practice location
535 E 17TH St
Idaho Falls, ID 83404-6154
Mailing address
535 E 17TH St
Idaho Falls, ID 83404-6154
Phone (208) 542-4569
Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.