Provider Demographics
NPI:1306254040
Name:CROWHORN, KIMBERLY N (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:N
Last Name:CROWHORN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8002
Mailing Address - Country:US
Mailing Address - Phone:208-455-0800
Mailing Address - Fax:208-461-8720
Practice Address - Street 1:5875 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5020
Practice Address - Country:US
Practice Address - Phone:208-461-8718
Practice Address - Fax:208-461-8720
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH00130901835P0018X
IDP6605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist