NPIMap

Organization Active NPI

Sandpoint Super Drug Clinical

  • Family Medicine Physician
  • Sandpoint, ID
National Provider Identifier
1104584739
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SANDPOINT SUPER DRUG CLINICAL
Practice address
604 N Fifth Ave
Sandpoint, ID 83864-1520
Phone
(208) 263-1408
NPI assigned
Dec 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Authorized official

Name
Scott Porter, PHARMDNPI 1326035494
Title
Authorized Official
Phone
(208) 263-1408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Clinic Pharmacy 3336C0002X

Addresses

Primary practice location

604 N Fifth Ave
Sandpoint, ID 83864-1520

Mailing address

604 N Fifth Ave
Sandpoint, ID 83864-1520
Phone (208) 263-1408

Other names 1

  • Sandpoint Super Drug Clinical Services Other name

National Provider Directory

National Provider Directory

Locations

604 N Fifth Ave
Sandpoint, ID 83864
Phone (208) 263-1408

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1104584739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 N FIFTH AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641520",
            "telephone_number": "208-263-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N FIFTH AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641520",
            "telephone_number": "208-263-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDPOINT SUPER DRUG CLINICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "208-263-1408",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandpoint Super Drug Clinical Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sandpoint Super Drug Clinical Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sandpoint, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.