Active NPI
Kohal Pharmacy Inc
- Community/Retail Pharmacy
- Pinehurst, ID
National Provider Identifier
1053453910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- KOHAL PHARMACY INC
- Practice address
- 504 N Division Ave
Pinehurst, ID 83850 - Phone
- (208) 682-3920
- Fax
- (208) 682-3939
- NPI assigned
- Feb 13, 2007
- Last updated
- Nov 26, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tony Wright, RPH
- Title
- Owner
- Phone
- (208) 682-4015
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 857CP | ID | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
504 N Division Ave
Pinehurst, ID 83850
Mailing address
PO Box 400
Pinehurst, ID 83850-0400
Phone (208) 682-4015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0025278 | Medicaid | ID |
Other names 1
- KOHAL PHARMACY INC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200521002387 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 9931226990 | Practice locations: Pinehurst, ID |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Durable Medical Equipment & Medical Supplies
- Pinehurst, ID
- NPI 1639202609
9931226990
National Provider Directory
National Provider Directory- Tax ID family
- Kohal Pharmacy Inc
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Kellogg, ID
- NPI 1588799902
-
- Durable Medical Equipment & Medical Supplies
- Pinehurst, ID
- NPI 1639202609
-
- Community/Retail Pharmacy
- Wallace, ID
- NPI 1821750738
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732579200000",
"number": "1053453910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "PINEHURST",
"state": "ID",
"postal_code": "838500400",
"telephone_number": "208-682-4015",
"fax_number": "208-682-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 N DIVISION AVE",
"city": "PINEHURST",
"state": "ID",
"postal_code": "83850",
"telephone_number": "208-682-3920",
"fax_number": "208-682-3939"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KOHAL PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-13",
"last_updated": "2024-11-26",
"certification_date": "2024-11-26",
"status": "A",
"authorized_official_last_name": "WRIGHT",
"authorized_official_first_name": "TONY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-682-4015",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "ID",
"license": "857CP",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0025278",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KOHAL PHARMACY INC",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Pinehurst, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.