Squad Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

SQUAD PHARMACY

Practice address

202 N 9TH St
Boise, ID 83702-5734

Phone

(208) 417-5249

NPI assigned

Dec 19, 2024

Organization subpart

No

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

Authorized official

Name

Mallika Khandelwal

Title

Ceo

Phone

(610) 955-2633

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1734566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1245048503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 BROADWAY APT 4C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100100007",
            "telephone_number": "610-955-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N 9TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025734",
            "telephone_number": "208-417-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUAD PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-19",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "KHANDELWAL",
        "authorized_official_first_name": "MALLIKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "610-955-2633"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.