Provider Demographics
NPI:1457642696
Name:JINDRICH, KATIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:JINDRICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 W HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3701
Mailing Address - Country:US
Mailing Address - Phone:503-828-6758
Mailing Address - Fax:
Practice Address - Street 1:1219 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3701
Practice Address - Country:US
Practice Address - Phone:208-433-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010773183500000X
IDP6786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist