Active NPI
Kenneth Richard Stark, PHARMD
- Pharmacist
- Boise, ID
National Provider Identifier
1255674164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6643
- Practice address
- 10555 W Overland Rd
Boise, ID 83709-1436 - Phone
- (208) 321-2669
- NPI assigned
- Mar 28, 2013
- Last updated
- Mar 28, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P6643 | ID | Primary |
| Pharmacist | 183500000X | CS18944 | ID | |
| Pharmacist | 183500000X | 6035703-1701 | UT | |
| Pharmacist | 183500000X | 6035703-8911 | UT | |
| Pharmacist | 183500000X | S019112 | AZ |
Addresses
Primary practice location
10555 W Overland Rd
Boise, ID 83709-1436
Mailing address
10555 W Overland Rd
Boise, ID 83709-1436
Phone (208) 321-2669
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S019112 | AZ | MD | Pharmacist |
| CS18944 | ID | MD | Pharmacist |
| P6643 | ID | MD | Pharmacist |
| 6035703-1701 | UT | MD | Pharmacist |
| 6035703-8911 | UT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364428800000",
"number": "1255674164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10555 W OVERLAND RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837091436",
"telephone_number": "208-321-2669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10555 W OVERLAND RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837091436",
"telephone_number": "208-321-2669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "KENNETH",
"middle_name": "RICHARD",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-28",
"last_updated": "2013-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6643",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "CS18944",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "6035703-1701",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "6035703-8911",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S019112",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.