Active NPI
Ashley Otis
- Community/Retail Pharmacy
- Chubbuck, ID
National Provider Identifier
1134711419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- P9227
- Practice address
- 4257 Yellowstone Ave
Chubbuck, ID 83202-2419 - Phone
- (208) 237-3940
- NPI assigned
- Feb 8, 2021
- Last updated
- Feb 8, 2021
- 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 |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | P9227 | ID | Primary |
Addresses
Primary practice location
4257 Yellowstone Ave
Chubbuck, ID 83202-2419
Mailing address
4257 Yellowstone Ave
Chubbuck, ID 83202-2419
Phone (208) 237-3940
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL |
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 |
|---|---|---|---|
| P9227 | ID | MD | Community/Retail Pharmacy |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
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": "1612742400000",
"number": "1134711419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4257 YELLOWSTONE AVE",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832022419",
"telephone_number": "208-237-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4257 YELLOWSTONE AVE",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832022419",
"telephone_number": "208-237-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "ASHLEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-08",
"last_updated": "2021-02-08",
"certification_date": "2021-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ID",
"license": "P9227",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "email",
"affiliation": "N",
"address_1": "4257 Yellowstone Ave",
"city": "Chubbuck",
"state": "ID",
"country_code": "US",
"postal_code": "832022419",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.