NPIMap

Individual provider Active NPI

Gregory Brent Wilding, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Burley, ID
National Provider Identifier
1619254604
Registry record updated Jun 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X
License
P9819 Issued in ID
Practice address
937 E Main St
Burley, ID 83318-2035
Phone
(208) 678-3286
Fax
(801) 678-1679
NPI assigned
Nov 4, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X P9819 ID Primary
Pharmacist 183500000X P9819 ID

Addresses

Primary practice location

937 E Main St
Burley, ID 83318-2035

Mailing address

937 E Main St
Burley, ID 83318-2035
Phone (208) 678-3286

Other practice location 1

1913 Addison Ave E
Twin Falls, ID 83301-5304
Phone (208) 734-4581

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
P9819IDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Mar 6, 2022 Accepting new patients
Smith's Food & Drug Centers Inc Past Accepting new patients
Smiths Food & Drug Centers Inc Past Accepting new patients
Smiths Food & Drug Centers Inc Past Accepting new patients
Walgreen Co Past 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": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780704000000",
    "number": "1619254604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "937 E MAIN ST",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182035",
            "telephone_number": "208-678-3286",
            "fax_number": "801-678-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "937 E MAIN ST",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182035",
            "telephone_number": "208-678-3286",
            "fax_number": "801-678-1679"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1913 Addison Ave E",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015304",
            "country_code": "US",
            "telephone_number": "208-734-4581",
            "fax_number": "208-736-7144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDING",
        "first_name": "GREGORY",
        "middle_name": "BRENT",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-04",
        "last_updated": "2026-06-06",
        "certification_date": "2026-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "ID",
            "license": "P9819",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P9819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.