Judd Alan Knudsen, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

P6023 Issued in ID

Practice address

1620 N Whitley Dr
Fruitland, ID 83619-2129

Phone

(208) 452-7075

Fax

(208) 452-7446

NPI assigned

Jun 21, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prescription Pad LLC

  • Community/Retail Pharmacy
  • Meridian, ID
  • NPI 1073133328
  NPD
• Prescription Pad LLC

  • Community/Retail Pharmacy
  • Fruitland, ID
  • NPI 1891102653
  NPD
• Ontario Pharmacy Inc

  • Compounding Pharmacy
  • Fruitland, ID
  • NPI 1659700896
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1104112903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 N WHITLEY DR",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192129",
            "telephone_number": "208-452-7075",
            "fax_number": "208-452-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 N WHITLEY DR",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192129",
            "telephone_number": "208-452-7075",
            "fax_number": "208-452-7446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1620 N Whitley Dr",
            "address_purpose": "LOCATION",
            "city": "Fruitland",
            "state": "ID",
            "postal_code": "836192129",
            "country_code": "US",
            "telephone_number": "208-452-7075",
            "fax_number": "208-452-7446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNUDSEN",
        "first_name": "JUDD",
        "middle_name": "ALAN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "15851",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P6023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Jones, LMSW
• Joseph D Ballenger Jr, DDS, PA
• Janette Kameshige, RPH
• Crysta Kimes, PA
• Nate Kinghorn
• Kira Koenig, PTA
• Kurt E Kracaw, MD
• Adam Robert Kramer, PHARMD
• Lacey Mackenzie Counseling
• Shawna Lafollette

• Pharmacist in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.