Provider Demographics
NPI:1396098075
Name:GIVENS, K LEANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:K
Middle Name:LEANNE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:KAY
Other - Middle Name:LEANNE
Other - Last Name:GIVENS-COLWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:425 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3402
Mailing Address - Country:US
Mailing Address - Phone:208-454-1111
Mailing Address - Fax:208-454-1066
Practice Address - Street 1:425 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3402
Practice Address - Country:US
Practice Address - Phone:208-454-1111
Practice Address - Fax:208-454-1066
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4296183500000X
NV07592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist