Individual provider Active NPI

Tony A Sandburg, PHARMD

  • Pharmacist
  • Nampa, ID
National Provider Identifier
1285910901
Registry record updated Oct 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
P6286 Issued in ID
Practice address
700 12TH Ave S
Nampa, ID 83651-4255
Phone
(208) 467-1560
Fax
(208) 467-1823
NPI assigned
Oct 26, 2011
Last updated
Oct 26, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X P6286 ID Primary

Addresses

Primary practice location

700 12TH Ave S
Nampa, ID 83651-4255

Mailing address

700 12TH Ave S
Nampa, ID 83651-4255
Phone (208) 467-1560

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
P6286IDMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1285910901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 12TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514255",
            "telephone_number": "208-467-1560",
            "fax_number": "208-467-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 12TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836514255",
            "telephone_number": "208-467-1560",
            "fax_number": "208-467-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDBURG",
        "first_name": "TONY",
        "middle_name": "A",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-26",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P6286",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 26, 2011; 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.