Kenneth Carlin K.c. Roose

NPI #1790566404 in Ammon, Idaho

Provider Information

NPI Number: 1790566404
Entity Type: Individual
Name: Kenneth Carlin K.c. Roose
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Oct 9, 2023
Last Updated: Oct 9, 2023

Practice Location

Address: 3250 E 17TH ST
City: Ammon
State: Idaho
ZIP Code: 83406-6758
Phone: (208) 552-7677

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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