Jesse Sue Wageman, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

E3950 Issued in ID

Practice address

4845 Yellowstone Ave
Chubbuck, ID 83202-2333

Phone

(208) 237-3900

NPI assigned

Jun 17, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Smiths Food & Drug Centers Inc

  • Community/Retail Pharmacy
  • Chubbuck, ID
  • NPI 1972528594
  NPD (past)
• Smith'S Food & Drug Centers Inc

  • Community/Retail Pharmacy
  • Henderson, NV
  • NPI 1881585248
  NPD (past)

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415577600000",
    "number": "1598050445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 EAST GILBERT AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838152333",
            "telephone_number": "208-916-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4845 YELLOWSTONE AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022333",
            "telephone_number": "208-237-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGEMAN",
        "first_name": "JESSE",
        "middle_name": "SUE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-17",
        "last_updated": "2014-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "E3950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Ulrich, M.S.CCC-SLP
• Rebecca Uses Arrow, BIS
• Mitchel B Vellinga, CMA, PA-C
• Geri Vialpando
• Kimberly Lind Wacaster, LCSW
• Walgreen Co
• Walmart Inc.
• John Cole Warburton, PHARMD
• Wesley Ward
• Jerralyn R Wasylyshen, PT

• Pharmacist in Chubbuck, ID
• Providers in Chubbuck, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; 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.