NPIMap

Organization Active NPI

Kohal Pharmacy Inc

  • Community/Retail Pharmacy
  • Wallace, ID
National Provider Identifier
1821750738
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KOHAL PHARMACY INC
Practice address
800 Bank St
Wallace, ID 83873-2306
Phone
(208) 752-1833
Fax
(208) 752-1831
NPI assigned
Oct 7, 2021
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
KOHAL PHARMACY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Tony Wright
Title
Owner
Phone
(208) 220-6150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

800 Bank St
Wallace, ID 83873-2306

Mailing address

800 Bank St
Wallace, ID 83873-2306
Phone (208) 752-1833

Other identifiers 1

IdentifierTypeStateIssuer
1821750738MedicaidID

Other names 1

  • Kohal Pharmacy Wallace Other name

National Provider Directory

National Provider Directory
Tax ID family
Kohal Pharmacy Inc6 organizations share this tax ID, including this one
Part of
Kohal Pharmacy Inc

Other organizations with this tax ID 5

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

Locations

800 Bank St
Wallace, ID 83873
Phone (208) 752-1833

NPI Registry JSON

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1821750738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BANK ST",
            "city": "WALLACE",
            "state": "ID",
            "postal_code": "838732306",
            "telephone_number": "208-752-1833",
            "fax_number": "208-752-1831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BANK ST",
            "city": "WALLACE",
            "state": "ID",
            "postal_code": "838732306",
            "telephone_number": "208-752-1833",
            "fax_number": "208-752-1831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOHAL PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOHAL PHARMACY INC",
        "enumeration_date": "2021-10-07",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-220-6150"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821750738",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kohal Pharmacy Wallace",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kohal Pharmacy Wallace",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wallace, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; 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.