Active NPI
Theodore Sandberg, PHARMD
- Pharmacist
- Coeur D Alene, ID
National Provider Identifier
1295584043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P11270
- Practice address
- 208 W Ironwood Dr
Coeur D Alene, ID 83814-2640 - Phone
- (208) 664-3185
- NPI assigned
- May 15, 2024
- Sex
- Male
- 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 | P11270 | ID | Primary |
Addresses
Primary practice location
208 W Ironwood Dr
Coeur D Alene, ID 83814-2640
Mailing address
3003 S Perry St Apt 52
Spokane, WA 99203-3986
Phone (253) 508-1900
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
| License | State | Type | Specialty |
|---|---|---|---|
| P11270 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1295584043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 S PERRY ST APT 52",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992033986",
"telephone_number": "253-508-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 W IRONWOOD DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142640",
"telephone_number": "208-664-3185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "THEODORE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-15",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P11270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.