Active NPI
Caleb Jackson
- Pharmacist
- Boise, ID
National Provider Identifier
1326706854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P9422
- Practice address
- 500 W Fort St
Boise, ID 83702-4501 - Phone
- (208) 422-1000
- NPI assigned
- Dec 1, 2021
- Last updated
- Dec 1, 2021
- 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 | P9422 | ID | Primary |
Addresses
Primary practice location
500 W Fort St
Boise, ID 83702-4501
Mailing address
2108 N 20TH St
Boise, ID 83702-0831
Phone (985) 991-1266
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P9422 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638316800000",
"number": "1326706854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2108 N 20TH ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837020831",
"telephone_number": "985-991-1266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W FORT ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837024501",
"telephone_number": "208-422-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CALEB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-01",
"last_updated": "2021-12-01",
"certification_date": "2021-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P9422",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.