Active NPI
Larry Lamar Ellis, RPH
- Pharmacist
- Driggs, ID
National Provider Identifier
1710138771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6051
- Practice address
- 10 S Main St
Driggs, ID 83422-9700 - Phone
- (208) 354-2334
- NPI assigned
- Oct 8, 2008
- Last updated
- Oct 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P6051 | ID | Primary |
Addresses
Primary practice location
10 S Main St
Driggs, ID 83422-9700
Mailing address
65 E Howard St
Driggs, ID 83422-5147
Phone (208) 354-3035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6051 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hunters Incorporated | Past | Accepting new patients | |
| Hunters Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Durable Medical Equipment & Medical Supplies
- Driggs, ID
- NPI 1710068259
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1710138771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 E HOWARD ST",
"city": "DRIGGS",
"state": "ID",
"postal_code": "834225147",
"telephone_number": "208-354-3035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 S MAIN ST",
"city": "DRIGGS",
"state": "ID",
"postal_code": "834229700",
"telephone_number": "208-354-2334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "LARRY",
"middle_name": "LAMAR",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Driggs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.