Active NPI
Angela Dawn Martin
- Pharmacist
- Boise, ID
National Provider Identifier
1194313593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P9175
- Practice address
- 7402 W Fairview Ave
Boise, ID 83704-8411 - Phone
- (208) 375-4670
- NPI assigned
- Jan 2, 2021
- Last updated
- Jan 2, 2021
- Sex
- Female
- Sole proprietor
- No
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 | P9175 | ID | Primary |
Addresses
Primary practice location
7402 W Fairview Ave
Boise, ID 83704-8411
Mailing address
7759 Elmore Rd
Fruitland, ID 83619-3528
Phone (208) 740-9750
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 |
|---|---|---|---|
| P9175 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho CVS Pharmacy LLC | Past | Accepting new patients | |
| Idaho CVS Pharmacy LLC | 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": "1609545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609545600000",
"number": "1194313593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7759 ELMORE RD",
"city": "FRUITLAND",
"state": "ID",
"postal_code": "836193528",
"telephone_number": "208-740-9750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7402 W FAIRVIEW AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837048411",
"telephone_number": "208-375-4670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ANGELA",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-02",
"last_updated": "2021-01-02",
"certification_date": "2021-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P9175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.