Active NPI
Bradley John Stoick, RPH BSPHARM
- Pharmacist
- Hailey, ID
National Provider Identifier
1376891002
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Feb 20, 2022.
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6590
- Practice address
- 911 N Main St
Hailey, ID 83333-8608 - Phone
- (208) 788-6716
- NPI assigned
- Aug 28, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P6590 | ID | Primary |
| Pharmacist | 183500000X | 2574 | MT |
Addresses
Primary practice location
911 N Main St
Hailey, ID 83333-8608
Mailing address
PO Box 2153
206 Meadows Loop
Ketchum, ID 83340
Phone (406) 531-7693
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6590 | ID | MD | Pharmacist |
| 2574 | MT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1376891002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2153",
"address_2": "206 MEADOWS LOOP",
"city": "KETCHUM",
"state": "ID",
"postal_code": "83340",
"telephone_number": "406-531-7693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 N MAIN ST",
"city": "HAILEY",
"state": "ID",
"postal_code": "833338608",
"telephone_number": "208-788-6716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOICK",
"first_name": "BRADLEY",
"middle_name": "JOHN",
"credential": "RPH BSPHARM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-28",
"last_updated": "2012-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6590",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MT",
"license": "2574",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hailey, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.