Active NPI
Madison Puryear
- Pharmacist
- Oldtown, ID
National Provider Identifier
1285313239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P10739
- Practice address
- 86 Tank Rd
Oldtown, ID 83822-5126 - Phone
- (208) 457-7160
- NPI assigned
- Jul 17, 2023
- 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 | P10739 | ID | Primary |
Addresses
Primary practice location
86 Tank Rd
Oldtown, ID 83822-5126
Mailing address
PO Box 458
Priest River, ID 83856-0458
Phone (208) 448-1633
Other practice location 1
31964 N 5th Ave
Spirit Lake, ID 83869-9472
Phone (208) 623-8485
Other practice location 2
5453 Highway 2
Priest River, ID 83856
Phone (208) 448-1633
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 |
|---|---|---|---|
| P10739 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deblaquiere Enterprises, Inc. | Current | Accepting new patients | |
| Deblaquiere Enterprises Inc | Past | Accepting new patients | |
| Deblaquiere Enterprises, Inc. | Past | Accepting new patients |
Locations
86 Tank Rd
Oldtown, ID 83822
Phone (208) 457-7160
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Oldtown, ID
- NPI 1841806494
-
- Community/Retail Pharmacy
- Spirit Lake, ID
- NPI 1477973832
-
- Community/Retail Pharmacy
- Priest River, ID
- NPI 1285621136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1285313239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 458",
"city": "PRIEST RIVER",
"state": "ID",
"postal_code": "838560458",
"telephone_number": "208-448-1633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 TANK RD",
"city": "OLDTOWN",
"state": "ID",
"postal_code": "838225126",
"telephone_number": "208-457-7160"
}
],
"practiceLocations": [
{
"address_1": "31964 N 5th Ave",
"address_purpose": "LOCATION",
"city": "Spirit Lake",
"state": "ID",
"postal_code": "838699472",
"country_code": "US",
"telephone_number": "208-623-8485",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5453 Highway 2",
"address_purpose": "LOCATION",
"city": "Priest River",
"state": "ID",
"postal_code": "83856",
"country_code": "US",
"telephone_number": "208-448-1633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PURYEAR",
"first_name": "MADISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-17",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P10739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oldtown, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.