NPIMap

Organization Active NPI

Ontario Pharmacy Inc

Doing business as Park-Vu Pharmacy

  • Community/Retail Pharmacy
  • Fruitland, ID
National Provider Identifier
1760564553
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
36033RP Issued in ID
Legal business name
ONTARIO PHARMACY INC
Doing business as
Park-Vu Pharmacy
Practice address
1118 NW 16TH St # 150
Fruitland, ID 83619-2271
Phone
(208) 452-7075
Fax
(208) 452-7446
NPI assigned
Oct 20, 2006
Last updated
Aug 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Authorized official

Name
Erin Jackson, PHARMDNPI 1447448154
Title
Pharmacist
Phone
(208) 452-7075

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 36033RP ID Primary

Addresses

Primary practice location

1118 NW 16TH St # 150
Fruitland, ID 83619-2271

Mailing address

1118 NW 16TH St # 150
Fruitland, ID 83619-2271
Phone (208) 452-7075

Other identifiers 3

IdentifierTypeStateIssuer
002430360MedicaidID
003355000MedicaidID
2020336OtherPK

Other names 1

  • PARK-VU PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ontario Pharmacy Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1118 NW 16th St
#150
Fruitland, ID 83619
Phone (208) 452-7075

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1760564553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 NW 16TH ST # 150",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192271",
            "telephone_number": "208-452-7075",
            "fax_number": "208-452-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 NW 16TH ST # 150",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192271",
            "telephone_number": "208-452-7075",
            "fax_number": "208-452-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONTARIO PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "208-452-7075",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "36033RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002430360",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003355000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020336",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK-VU PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; 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.