Provider Demographics
NPI:1992547897
Name:PKHW LLC
Entity type:Organization
Organization Name:PKHW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PEACH-KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-203-1355
Mailing Address - Street 1:3715 E OVERLAND RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8301
Mailing Address - Country:US
Mailing Address - Phone:208-203-1355
Mailing Address - Fax:208-203-7800
Practice Address - Street 1:3715 E OVERLAND RD STE 115
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8301
Practice Address - Country:US
Practice Address - Phone:208-203-1355
Practice Address - Fax:208-203-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy