Provider Demographics
NPI:1417394966
Name:WAINAINA, KENNEDY KAMBO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:KAMBO
Last Name:WAINAINA
Suffix:
Gender:M
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 1:2937 S BAY STAR WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3094
Mailing Address - Country:US
Mailing Address - Phone:208-440-3512
Mailing Address - Fax:
Practice Address - Street 1:10477 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8008
Practice Address - Country:US
Practice Address - Phone:208-377-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5825183500000X
OR0010516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist