NPIMap

Organization Active NPI

Idaho State University

  • Health Service Clinic/Center
  • Chubbuck, ID
National Provider Identifier
1457060790
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
IDAHO STATE UNIVERSITY
Practice address
4914 Yellowstone Ave Ste B
Chubbuck, ID 83202-2332
Phone
(208) 282-2005
NPI assigned
Nov 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Authorized official

Name
Cynthia Lee Rock
Title
Clinics Director of Operations
Phone
(208) 373-1743

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Care PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 1835P2201X
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

4914 Yellowstone Ave Ste B
Chubbuck, ID 83202-2332

Mailing address

990 S 8TH Ave Stop 8158
Pocatello, ID 83201-4982
Phone (800) 627-4781

Other names 1

  • ISU Pharmacist Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Idaho State University22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

4914 Yellowstone Ave
Ste B
Chubbuck, ID 83202
Phone (208) 282-2005

4914 Yellowstone Ave
Ste A
Chubbuck, ID 83202
Phone (208) 282-5790

NPI Registry JSON

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1457060790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 S 8TH AVE STOP 8158",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014982",
            "telephone_number": "800-627-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4914 YELLOWSTONE AVE STE B",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022332",
            "telephone_number": "208-282-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CLINICS DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "208-373-1743"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Ambulatory Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISU Pharmacist Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "ISU Pharmacist Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chubbuck, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.