Provider Demographics
NPI:1083928832
Name:K2RED LLC
Entity Type:Organization
Organization Name:K2RED LLC
Other - Org Name:BUHL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-543-5353
Mailing Address - Street 1:419 BROADWAY AVE S
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316
Mailing Address - Country:US
Mailing Address - Phone:208-543-5353
Mailing Address - Fax:208-543-2202
Practice Address - Street 1:419 BROADWAY AVE S
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1310
Practice Address - Country:US
Practice Address - Phone:208-543-5353
Practice Address - Fax:208-543-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ID14706RP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1083928832Medicaid
2126140OtherPK
2126140OtherPK