Active NPI
Zachary Rex Gundersen, PHARMD
- Pharmacist
- Rexburg, ID
National Provider Identifier
1316672132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P10090
- Practice address
- 164 E Main St
Rexburg, ID 83440-1912 - Phone
- (208) 227-5076
- NPI assigned
- Jul 18, 2022
- Last updated
- Jul 18, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P10090 | ID | Primary |
Addresses
Primary practice location
164 E Main St
Rexburg, ID 83440-1912
Mailing address
164 E Main St
Rexburg, ID 83440-1912
Phone (208) 227-5076
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 |
|---|---|---|---|
| P10090 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
164 E Main St
Rexburg, ID 83440
Phone (208) 227-5076
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1316672132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401912",
"telephone_number": "208-227-5076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401912",
"telephone_number": "208-227-5076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSEN",
"first_name": "ZACHARY",
"middle_name": "REX",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-18",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P10090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.