Active NPI
Gregory Nelsen
- Pharmacist
- Jerome, ID
National Provider Identifier
1275764482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6278
- Practice address
- 253 E 650 N
Jerome, ID 83338-5035 - Phone
- (623) 687-1562
- NPI assigned
- Aug 5, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P-001165 | OR | |
| Pharmacist | 183500000X | P6278 | ID | Primary |
Addresses
Primary practice location
253 E 650 N
Jerome, ID 83338-5035
Mailing address
253 E 650 N
Jerome, ID 83338-5035
Phone (623) 687-1562
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 |
|---|---|---|---|
| P6278 | ID | MD | Pharmacist |
| P-001165 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249430400000",
"number": "1275764482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "253 E 650 N",
"city": "JEROME",
"state": "ID",
"postal_code": "833385035",
"telephone_number": "623-687-1562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "253 E 650 N",
"city": "JEROME",
"state": "ID",
"postal_code": "833385035",
"telephone_number": "623-687-1562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSEN",
"first_name": "GREGORY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-05",
"last_updated": "2009-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "P-001165",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jerome, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.