Provider Demographics
NPI:1295008969
Name:INSELMAN, KENNETH ROY (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROY
Last Name:INSELMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 W HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9738
Mailing Address - Country:US
Mailing Address - Phone:208-272-9454
Mailing Address - Fax:208-272-9460
Practice Address - Street 1:179 W HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9738
Practice Address - Country:US
Practice Address - Phone:208-272-9454
Practice Address - Fax:208-272-9460
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3625183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist