Active NPI
Robert Jay Anderson, PHARMD, RPH.
- Pharmacist
- Caldwell, ID
National Provider Identifier
1750849832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P8202
- Practice address
- 4605 Enterprise Way Ste 102
Caldwell, ID 83605-6889 - Phone
- (208) 855-0701
- NPI assigned
- Mar 7, 2019
- Last updated
- Apr 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | P8202 | ID | Primary |
Addresses
Primary practice location
4605 Enterprise Way Ste 102
Caldwell, ID 83605-6889
Mailing address
675 Beck Rd
Nyssa, OR 97913-5119
Phone (208) 680-5786
Other practice location 1
2667 E Gala Ct Ste 125
Meridian, ID 83642-2789
Phone (208) 855-0701
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P8202 | Other | ID | IDAHO PHARMACIST LICENSE |
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P8202 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| P. Roman Burk DPM PC | Current | Accepting new patients | |
| P. Roman Burk DPM PC | Past | Accepting new patients |
Locations
4605 Enterprise Way
Ste 102
Caldwell, ID 83605
Phone (208) 795-5090
2667 E Gala Ct
Ste 125
Meridian, ID 83642
Phone (208) 855-0701
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712793600000",
"number": "1750849832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 BECK RD",
"city": "NYSSA",
"state": "OR",
"postal_code": "979135119",
"telephone_number": "208-680-5786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4605 ENTERPRISE WAY STE 102",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836056889",
"telephone_number": "208-855-0701"
}
],
"practiceLocations": [
{
"address_1": "2667 E Gala Ct Ste 125",
"address_purpose": "LOCATION",
"city": "Meridian",
"state": "ID",
"postal_code": "836422789",
"country_code": "US",
"telephone_number": "208-855-0701",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "ROBERT",
"middle_name": "JAY",
"credential": "PHARMD, RPH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-07",
"last_updated": "2024-04-11",
"certification_date": "2024-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P8202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO PHARMACIST LICENSE",
"identifier": "P8202",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.