Active NPI
Todd Carlton Hansen
- Pharmacist
- Ammon, ID
National Provider Identifier
1194204255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5256
- Practice address
- 3250 Midway Dr
Ammon, ID 83406-7650 - Phone
- (208) 552-7677
- NPI assigned
- Aug 9, 2018
- Sex
- Male
- 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 | P5256 | ID | Primary |
Addresses
Primary practice location
3250 Midway Dr
Ammon, ID 83406-7650
Mailing address
1102 Killarney Ave
Idaho Falls, ID 83404-6845
Phone (208) 390-9100
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 |
|---|---|---|---|
| P5256 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1194204255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1102 KILLARNEY AVE",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046845",
"telephone_number": "208-390-9100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 MIDWAY DR",
"city": "AMMON",
"state": "ID",
"postal_code": "834067650",
"telephone_number": "208-552-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "TODD",
"middle_name": "CARLTON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-09",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.