NPIMap

Organization Active NPI

Vic's Family Pharmacy Inc

  • Pharmacy
  • Kuna, ID
National Provider Identifier
1669460093
Registry record updated Oct 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
1271CP Issued in ID
Legal business name
VIC'S FAMILY PHARMACY INC
Practice address
173 E 4TH St
Kuna, ID 83634-2103
Phone
(208) 922-4400
Fax
(208) 922-4499
NPI assigned
Oct 10, 2005
Last updated
Oct 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2009

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

Authorized official

Name
Mr. Travis L Walthall, RPHNPI 1144566894
Title
Pharmacist in Charge
Phone
(208) 922-4400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 1271CP ID Primary

Addresses

Primary practice location

173 E 4TH St
Kuna, ID 83634-2103

Mailing address

119 S Valley Dr Ste a
Nampa, ID 83686-2985
Phone (208) 922-4400

Other identifiers 3

IdentifierTypeStateIssuer
1306251OtherIDNATL ASSO BOARD OF PHARMA
8044295400MedicaidID
1271CPOtherIDBOARD OF PHARMACY

National Provider Directory

National Provider Directory
Tax ID family
Vics Family Pharmacy Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256774400000",
    "number": "1669460093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 S VALLEY DR STE A",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836862985",
            "telephone_number": "208-922-4400",
            "fax_number": "208-922-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 E 4TH ST",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836342103",
            "telephone_number": "208-922-4400",
            "fax_number": "208-922-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIC'S FAMILY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2009-10-29",
        "status": "A",
        "authorized_official_last_name": "WALTHALL",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "208-922-4400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "ID",
            "license": "1271CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATL ASSO BOARD OF PHARMA",
            "identifier": "1306251",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8044295400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "1271CP",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kuna, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; 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.