NPIMap

Organization Active NPI

State of Idaho-Dba Idaho State School & Hospital Pharmacy

  • Institutional Pharmacy
  • Nampa, ID
National Provider Identifier
1265559314
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
539-HP Issued in ID
Legal business name
STATE OF IDAHO-DBA IDAHO STATE SCHOOL & HOSPITAL PHARMACY
Practice address
1660 11TH Ave N
Nampa, ID 83687-5000
Phone
(208) 442-2812
Fax
(208) 467-3406
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Susan Broetje
Title
Administrative Director
Phone
(208) 442-2812

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 539-HP ID Primary

Addresses

Primary practice location

1660 11TH Ave N
Nampa, ID 83687-5000

Mailing address

1660 11TH Ave N
Nampa, ID 83687-5000
Phone (208) 442-2812

Other identifiers 1

IdentifierTypeStateIssuer
0028335600MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Reg VI Mental Health Ctr114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1660 11th Ave N
Nampa, ID 83687
Phone (208) 442-2812

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265559314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 11TH AVE N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875000",
            "telephone_number": "208-442-2812",
            "fax_number": "208-467-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 11TH AVE N",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836875000",
            "telephone_number": "208-442-2812",
            "fax_number": "208-467-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF IDAHO-DBA IDAHO STATE SCHOOL & HOSPITAL PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROETJE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "208-442-2812"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "ID",
            "license": "539-HP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028335600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.