NPIMap

Organization Active NPI

Idaho State Veteran Home - Lewiston

  • Long Term Care Pharmacy
  • Lewiston, ID
National Provider Identifier
1689687261
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
1042HP Issued in ID
Legal business name
IDAHO STATE VETERAN HOME - LEWISTON
Practice address
821 21St Ave
Lewiston, ID 83501-6389
Phone
(208) 799-3422
Fax
(208) 743-8833
NPI assigned
Aug 14, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Mr. K Douglas Crafton, RPH
Title
Director of Pharmacy
Phone
(208) 799-3422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 1042HP ID Primary

Addresses

Primary practice location

821 21St Ave
Lewiston, ID 83501-6389

Mailing address

821 21St Ave
Lewiston, ID 83501-6389
Phone (208) 799-3422

Other identifiers 1

IdentifierTypeStateIssuer
1307102OtherIDNCPDP NUMBER

National Provider Directory

National Provider Directory
Tax ID family
District 7 Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1689687261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 21ST AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016389",
            "telephone_number": "208-799-3422",
            "fax_number": "208-743-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 21ST AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016389",
            "telephone_number": "208-799-3422",
            "fax_number": "208-743-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO STATE VETERAN HOME - LEWISTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CRAFTON",
        "authorized_official_first_name": "K DOUGLAS",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "208-799-3422",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "ID",
            "license": "1042HP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "1307102",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.