Provider Demographics
NPI:1447669809
Name:HYDE, KRISTEN (PHARM D, RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 SECOND ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-465-2836
Mailing Address - Fax:208-429-6427
Practice Address - Street 1:5230 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1109
Practice Address - Country:US
Practice Address - Phone:208-429-6433
Practice Address - Fax:208-429-6427
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist