NPIMap

Organization Active NPI

Teton Clinical Pharmacy Inc

Doing business as Teton Pharmacy

  • Community/Retail Pharmacy
  • Idaho Falls, ID
National Provider Identifier
1316949910
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2226RP Issued in ID
Legal business name
TETON CLINICAL PHARMACY INC
Doing business as
Teton Pharmacy
Practice address
2470 Jafer CT
Idaho Falls, ID 83404-5587
Phone
(208) 529-3636
Fax
(208) 528-6562
NPI assigned
Aug 12, 2005
Last updated
Jul 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

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

Authorized official

Name
Jason Bailey, PHARMD
Title
Owner
Phone
(208) 529-3636

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 2226RP ID Primary
Home Infusion Therapy Pharmacy 3336H0001X NU

Addresses

Primary practice location

2470 Jafer CT
Idaho Falls, ID 83404-5587

Mailing address

2470 Jafer CT
Idaho Falls, ID 83404-5587
Phone (208) 529-3636

Other identifiers 3

IdentifierTypeStateIssuer
1043629397MedicaidID
2020627OtherPK
002551700MedicaidID

Other names 1

  • TETON PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Teton Clinical Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2470 Jafer Ct
Idaho Falls, ID 83404
Phone (208) 529-3636

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1316949910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 JAFER CT",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045587",
            "telephone_number": "208-529-3636",
            "fax_number": "208-528-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 JAFER CT",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045587",
            "telephone_number": "208-529-3636",
            "fax_number": "208-528-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON CLINICAL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-12",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-529-3636",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "2226RP",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043629397",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020627",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002551700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TETON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; 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.