NPIMap

Organization Active NPI

Ladd Family Pharmacy LLC

  • Community/Retail Pharmacy
  • Mountain Home, ID
National Provider Identifier
1679082945
Registry record updated Sep 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
46393LS Issued in ID
Legal business name
LADD FAMILY PHARMACY LLC
Practice address
2000 American Legion Blvd
Mountain Home, ID 83647-3138
Phone
(208) 947-0877
Fax
(208) 947-0874
NPI assigned
Sep 29, 2017
Last updated
Sep 29, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
LADD FAMILY PHARMACY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2017

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

Authorized official

Name
Jeremy Lundevall
Title
C.O.O
Phone
(208) 947-0877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 46393LS ID Primary

Addresses

Primary practice location

2000 American Legion Blvd
Mountain Home, ID 83647-3138

Mailing address

1109 S Broadway Ave
Boise, ID 83706-3626
Phone (208) 947-0877

National Provider Directory

National Provider Directory
Part of
Ladd Family Pharmacy LLC

Locations

2000 American Legion Blvd
Mountain Home, ID 83647
Phone (208) 587-1500

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506643200000",
    "number": "1679082945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 S BROADWAY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063626",
            "telephone_number": "208-947-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 AMERICAN LEGION BLVD",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836473138",
            "telephone_number": "208-947-0877",
            "fax_number": "208-947-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LADD FAMILY PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LADD FAMILY PHARMACY LLC",
        "enumeration_date": "2017-09-29",
        "last_updated": "2017-09-29",
        "status": "A",
        "authorized_official_last_name": "LUNDEVALL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "C.O.O",
        "authorized_official_telephone_number": "208-947-0877"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "46393LS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; 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.