Active NPI
Brad Berry, PHARM.D.
- Pharmacist
- Idaho Falls, ID
National Provider Identifier
1518151018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5358
- Practice address
- 1790 Deer Valley Dr
Idaho Falls, ID 83401-6800 - Phone
- (208) 520-0088
- NPI assigned
- Aug 28, 2007
- Last updated
- Aug 28, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P5358 | ID | Primary |
Addresses
Primary practice location
1790 Deer Valley Dr
Idaho Falls, ID 83401-6800
Mailing address
535 E 17TH St
Idaho Falls, ID 83404-6154
Phone (208) 542-4569
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
| License | State | Type | Specialty |
|---|---|---|---|
| P5358 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188259200000",
"number": "1518151018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 E 17TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046154",
"telephone_number": "208-542-4569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1790 DEER VALLEY DR",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834016800",
"telephone_number": "208-520-0088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "BRAD",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-28",
"last_updated": "2007-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.