NPIMap

Individual provider Active NPI

Alyssa Renae Zibrowski, PHARM.D.

  • Pharmacist
  • Eagle, ID
National Provider Identifier
1447710728
Registry record updated Jul 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
P8236 Issued in ID
Practice address
149 W State St Ste 101
Eagle, ID 83616-4911
Phone
(208) 939-8008
NPI assigned
Mar 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 123392 MN
Pharmacist 183500000X P8236 ID Primary

Addresses

Primary practice location

149 W State St Ste 101
Eagle, ID 83616-4911

Mailing address

477 N Whitewater Park Blvd Apt C107
Boise, ID 83702-5684
Phone (309) 721-4700

Other practice location 1

1915 W State St
Boise, ID 83702-3958
Phone (208) 515-2211

Other names 1

  • Ms. Alyssa Renae Bush Former name

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

LicenseStateTypeSpecialty
P8236IDMDPharmacist
123392MNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Customedica Pharmacy Inc PastSince Jul 28, 2019 Accepting new patients
Customedica Pharmacy Inc PastSince Jul 28, 2019 Accepting new patients
Customedica Pharmacy Inc Past Accepting new patients
Walgreen Co Past Accepting new patients
Walgreen Co PastSince Mar 6, 2022 Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563580800000",
    "number": "1447710728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N WHITEWATER PARK BLVD APT C107",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025684",
            "telephone_number": "309-721-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W STATE ST STE 101",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164911",
            "telephone_number": "208-939-8008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1915 W State St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837023958",
            "country_code": "US",
            "telephone_number": "208-515-2211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZIBROWSKI",
        "first_name": "ALYSSA",
        "middle_name": "RENAE",
        "name_prefix": "Mrs.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2019-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "123392",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P8236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "BUSH",
            "middle_name": "RENAE",
            "prefix": "MS.",
            "credential": "PHARM.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2019; 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.