John Willis

Primary specialty

PharmacistTaxonomy code 183500000X

License

12477 Issued in MT

Practice address

6452 Main St
Bonners Ferry, ID 83805-8520

Phone

(208) 267-4021

Fax

(208) 267-4024

NPI assigned

Mar 17, 2014

Sex

Male

Sole proprietor

No

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

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.

• Medicine Man Bonners Ferry Pharmacy LLC

  • Community/Retail Pharmacy
  • Bonners Ferry, ID
  • NPI 1578826178
  NPD (past)

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1619393493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 MAIN ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058520",
            "telephone_number": "208-267-4021",
            "fax_number": "208-267-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6452 MAIN ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058520",
            "telephone_number": "208-267-4021",
            "fax_number": "208-267-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-17",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "12477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn L Wenzel, LCSW
• Robert B. Wenzel, LCPC
• Wild Life Community Counseling PLLC
• Wildwood L.L.C
• Henry SK Willis IV, D.D.S.
• Stuart Kendall Willis III, MD
• William Lamont Worden, MD
• Kelli L Wright, LCSW
• Robert Yost, MD

• Pharmacist in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.