Bear Lake Drug LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1440RP Issued in ID

Legal business name

BEAR LAKE DRUG LLC

Doing business as

Bear Lake Drug L.L.C.

Practice address

836 Washington St
Montpelier, ID 83254-1423

Phone

(208) 847-1421

Fax

(208) 847-1690

NPI assigned

Jun 18, 2014

Last updated

Jan 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Casey HumpherysNPI 1720335664

Title

Pharmd

Phone

(208) 847-1421

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bear Lake Drug L.L.C. Doing business as

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Practitioners 2

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.

• Casey Humpherys

  • Pharmacist
  • Montpelier, ID
  • NPI 1720335664
  NPD Authorized official
• Dean A Wallentine, PHARM D.

  • Pharmacist
  • Montpelier, ID
  • NPI 1265425433

  Community/Retail Pharmacy

  NPD (past)

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1861806820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 WASHINGTON ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541423",
            "telephone_number": "208-847-1421",
            "fax_number": "208-847-1690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 WASHINGTON ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541423",
            "telephone_number": "208-847-1421",
            "fax_number": "208-847-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "HUMPHERYS",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "PHARMD",
        "authorized_official_telephone_number": "208-847-1421"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "1440RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147038",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Drug L.L.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bear Lake County Memorial Hospital (Bear Lake Family Care and OB/GYN)
• Bear Lake County Memorial Hospital (Bear Lake Memorial Hospital Pharmacy)
• Bear Lake County Memorial Hospital
• Bear Lake County Memorial Hospital (Bear Lake Family Care and OB/GYN)
• Bear Lake Dental Care, PLLC
• Bear Lake Memorial Hospital
• Bear Lake Memorial Hospital (Bear Lake Manor)
• Bear Lake Physical and Sports Therapy PC
• Richard Bergman, LSW
• Mark Berning, PHARMD

• Community/Retail Pharmacy in Montpelier, ID
• Providers in Montpelier, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.