Kirsten Hansen Blair, RPH
Individual provider Active NPI Pharmacist · Chubbuck, ID
NPI 1912424375 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1912424375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P7796 (ID)
- Practice address
- 4215 Yellowstone Ave
Chubbuck, ID 83202-2419 - Phone
- (208) 237-6828
- NPI assigned
- Aug 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P7796 | ID | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P7796 | ID | Yes |
Addresses
Primary practice location
4215 Yellowstone Ave
Chubbuck, ID 83202-2419
Mailing address
4215 Yellowstone
Chubbuck, ID 83202
Other practice location 1
305 W Quinn Rd
Pocatello, ID 83201-4988
Phone (208) 238-4049
Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. 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.