Active NPI
Kohal Pharmacy Inc
- Durable Medical Equipment & Medical Supplies
- Pinehurst, ID
National Provider Identifier
1639202609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 857CP
- Legal business name
- KOHAL PHARMACY INC
- Practice address
- 504 North Division Ave
Pinehurst, ID 83850 - Phone
- (208) 682-4015
- Fax
- (208) 682-3939
- NPI assigned
- Mar 13, 2007
- Last updated
- Jul 1, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tony Wright
- Title
- Owner
- Phone
- (208) 682-4015
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 857CP | ID | Primary |
Addresses
Primary practice location
504 North Division Ave
Pinehurst, ID 83850
Mailing address
PO Box 400
Pinehurst, ID 83850-0400
Phone (208) 682-4015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002528000 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930038036 | ID | DME Supplier - Pharmacy | 9931226990 | Practice locations: Pinehurst, ID |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Kohal Pharmacy Inc
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Pinehurst, ID
- NPI 1053453910
-
- Community/Retail Pharmacy
- Kellogg, ID
- NPI 1588799902
-
- Community/Retail Pharmacy
- Wallace, ID
- NPI 1821750738
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1719792000000",
"number": "1639202609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "PINEHURST",
"state": "ID",
"postal_code": "838500400",
"telephone_number": "208-682-4015",
"fax_number": "208-682-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 NORTH DIVISION AVE",
"city": "PINEHURST",
"state": "ID",
"postal_code": "83850",
"telephone_number": "208-682-4015",
"fax_number": "208-682-3939"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KOHAL PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-13",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A",
"authorized_official_last_name": "WRIGHT",
"authorized_official_first_name": "TONY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-682-4015"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "ID",
"license": "857CP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002528000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pinehurst, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.