Active NPI
Maggi Bradley
- Pharmacist
- Idaho Falls, ID
National Provider Identifier
1083206353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P9191
- Practice address
- 2375 E Sunnyside Rd
Idaho Falls, ID 83404-8280 - Phone
- (208) 623-8614
- NPI assigned
- Feb 8, 2021
- Last updated
- Mar 27, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P9191 | ID | Primary |
Addresses
Primary practice location
2375 E Sunnyside Rd
Idaho Falls, ID 83404-8280
Mailing address
2375 E Sunnyside Rd
Idaho Falls, ID 83404-8280
Phone (208) 530-2039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P9191 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1604 W Broadway St
Idaho Falls, ID 83402
Phone (208) 522-4655
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774569600000",
"number": "1083206353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2375 E SUNNYSIDE RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834048280",
"telephone_number": "208-530-2039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2375 E SUNNYSIDE RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834048280",
"telephone_number": "208-623-8614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "MAGGI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-08",
"last_updated": "2026-03-27",
"certification_date": "2026-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P9191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.