Active NPI
Kohner Warren
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Meridian, ID
National Provider Identifier
1023724333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- P10457
- Practice address
- 1400 W Chinden Blvd
Meridian, ID 83646-5328 - Phone
- (208) 893-6033
- NPI assigned
- Jan 30, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | P10457 | ID | Primary |
Addresses
Primary practice location
1400 W Chinden Blvd
Meridian, ID 83646-5328
Mailing address
3916 W Cassia St
Boise, ID 83705-2111
Phone (509) 508-7591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10457 | ID | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc | Current | Accepting new patients | |
| Fred Meyer Stores Inc. | Past | Accepting new patients |
Locations
1400 W Chinden Blvd
Meridian, ID 83646
Phone (208) 893-6033
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Fred Meyer Pharmacy #685
- Community/Retail Pharmacy
- Meridian, ID
- NPI 1508132069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675036800000",
"number": "1023724333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3916 W CASSIA ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837052111",
"telephone_number": "509-508-7591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W CHINDEN BLVD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465328",
"telephone_number": "208-893-6033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "KOHNER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-30",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "ID",
"license": "P10457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.