NPIMap

Organization Active NPI

Ed Snell'S Pharmacy Shop

  • Community/Retail Pharmacy
  • Pocatello, ID
National Provider Identifier
1356367486
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P4033 Issued in ID
Legal business name
ED SNELL'S PHARMACY SHOP
Practice address
1015 E Young St
Pocatello, ID 83201-5282
Phone
(208) 232-0049
Fax
(208) 232-3963
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Mr. Ed Snell, RPH, CCN
Title
President
Phone
(208) 232-0049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X P4033 ID Primary

Addresses

Primary practice location

1015 E Young St
Pocatello, ID 83201-5282

Mailing address

1015 E Young St
Pocatello, ID 83201-5282
Phone (208) 232-0049

Other identifiers 3

IdentifierTypeStateIssuer
8C451OtherIDBLUE CROSS OF IDAHO ID #
000010013849OtherIDBLUE CROSS OF IDAHO ID #
002631600MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Ed Snell'S Pharmacy Shop3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1356367486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 E YOUNG ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015282",
            "telephone_number": "208-232-0049",
            "fax_number": "208-232-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 E YOUNG ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015282",
            "telephone_number": "208-232-0049",
            "fax_number": "208-232-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ED SNELL'S PHARMACY SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "SNELL",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-232-0049",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH, CCN"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "P4033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO ID #",
            "identifier": "8C451",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO ID #",
            "identifier": "000010013849",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002631600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.