Active NPI
Kenneth Dirk, PHARMD,MBA
- Pharmacist
- Boise, ID
National Provider Identifier
1447478151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5175
- Practice address
- 1219 Broadway Ave
Boise, ID 83706-3701 - Phone
- (208) 433-9905
- Fax
- (208) 433-9907
- NPI assigned
- Apr 20, 2007
- 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 | 183500000X | P5175 | ID | Primary |
Addresses
Primary practice location
1219 Broadway Ave
Boise, ID 83706-3701
Mailing address
4636 E Narcissus CT
Boise, ID 83716-7002
Phone (208) 433-8721
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
- Master of Business Administration, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P5175 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447478151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4636 E NARCISSUS CT",
"city": "BOISE",
"state": "ID",
"postal_code": "837167002",
"telephone_number": "208-433-8721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1219 BROADWAY AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837063701",
"telephone_number": "208-433-9905",
"fax_number": "208-433-9907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIRK",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PHARMD,MBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5175",
"primary": true
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.