NPIMap

Organization Active NPI

Cardinal Health 132, LLC

Doing business as Syringa Clinic Pharmacy

  • Community/Retail Pharmacy
  • Grangeville, ID
National Provider Identifier
1164966271
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
43791RP Issued in ID
Legal business name
CARDINAL HEALTH 132, LLC
Doing business as
Syringa Clinic Pharmacy
Practice address
607 W Main St
Suite 100
Grangeville, ID 83530-1345
Phone
(208) 494-3050
Fax
(208) 983-1915
NPI assigned
Dec 8, 2016
Last updated
Sep 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CARDINAL HEALTH 132, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Authorized official

Name
Michael Brown
Title
Vice President, Managed Services
Phone
(281) 749-4764

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 43791RP ID Primary

Addresses

Primary practice location

607 W Main St
Suite 100
Grangeville, ID 83530-1345

Mailing address

13651 Dublin CT
Stafford, TX 77477-4317
Phone (281) 749-4000

Other names 1

  • Syringa Clinic Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171018001765 ID Part B Supplier - Mass Immunization (Roster Biller Only) 4688961501 Practice locations: Grangeville, ID

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Cardinal Health 132 LLC11 organizations share this tax ID, including this one
Part of
Cardinal Health 132 LLC

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

607 W Main St
Ste 100
Grangeville, ID 83530
Phone (208) 494-3050

NPI Registry JSON

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

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1164966271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13651 DUBLIN CT",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774774317",
            "telephone_number": "281-749-4000",
            "fax_number": "614-652-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301345",
            "telephone_number": "208-494-3050",
            "fax_number": "208-983-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL HEALTH 132, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARDINAL HEALTH 132, LLC",
        "enumeration_date": "2016-12-08",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT, MANAGED SERVICES",
        "authorized_official_telephone_number": "281-749-4764"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "43791RP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Syringa Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Syringa Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grangeville, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.

Verify at the official NPI Registry.