NPIMap

Organization Active NPI

R & J Pharmacy, Inc.

Doing business as Pharmacy Shop

  • Pharmacy
  • Blackfoot, ID
National Provider Identifier
1285635169
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
1907CP Issued in ID
Legal business name
R & J PHARMACY, INC.
Doing business as
Pharmacy Shop
Practice address
69 N Pine St
Blackfoot, ID 83221-2053
Phone
(208) 785-3510
Fax
(208) 785-7317
NPI assigned
Aug 2, 2005
Last updated
May 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Authorized official

Name
Mr. Robert Nathan Miller, PHARMDNPI 1134691199
Title
President
Phone
(208) 785-3510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 1907CP ID Primary

Addresses

Primary practice location

69 N Pine St
Blackfoot, ID 83221-2053

Mailing address

69 N Pine St
Blackfoot, ID 83221-2053
Phone (208) 785-3510

Other identifiers 3

IdentifierTypeStateIssuer
1300514/8L386OtherIDBLUE CROSS
807034200MedicaidID
807071700MedicaidID

Other names 1

  • Pharmacy Shop Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211109000629 ID Part B Supplier - Mass Immunization (Roster Biller Only) 3072723923 Practice locations: Blackfoot, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1285635169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 N PINE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212053",
            "telephone_number": "208-785-3510",
            "fax_number": "208-785-7317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 N PINE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212053",
            "telephone_number": "208-785-3510",
            "fax_number": "208-785-7317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R & J PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-785-3510",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "ID",
            "license": "1907CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1300514/8L386",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807034200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807071700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.