Active NPI
Clinton J Thackeray
- Pharmacist
- Rigby, ID
National Provider Identifier
1780937151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6368
- Practice address
- 150 N State St
Rigby, ID 83442-1443 - Phone
- (208) 745-0267
- NPI assigned
- Oct 22, 2012
- 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 | P6368 | ID | Primary |
Addresses
Primary practice location
150 N State St
Rigby, ID 83442-1443
Mailing address
150 N State St
Rigby, ID 83442-1443
Phone (208) 745-0267
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6368 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461024000000",
"number": "1780937151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 N STATE ST",
"city": "RIGBY",
"state": "ID",
"postal_code": "834421443",
"telephone_number": "208-745-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 N STATE ST",
"city": "RIGBY",
"state": "ID",
"postal_code": "834421443",
"telephone_number": "208-745-0267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THACKERAY",
"first_name": "CLINTON",
"middle_name": "J",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-22",
"last_updated": "2016-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rigby, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.