NPIMap

Organization Active NPI

Rosauers Supermarkets Inc

Doing business as Super 1 Pharmacy

  • Community/Retail Pharmacy
  • Ellensburg, WA
National Provider Identifier
1952399388
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
262010403851 Issued in WA
Legal business name
ROSAUERS SUPERMARKETS INC
Doing business as
Super 1 Pharmacy
Practice address
200 E Mountain View Ave
Ellensburg, WA 98926-3771
Phone
(509) 962-7777
Fax
(509) 962-7785
NPI assigned
Oct 10, 2005
Last updated
Sep 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Jeffry Philipps, RPH
Title
Pres
Phone
(509) 326-8900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 262010403851 WA Primary

Addresses

Primary practice location

200 E Mountain View Ave
Ellensburg, WA 98926-3771

Mailing address

PO Box 9000
Spokane, WA 99209-9000

Other identifiers 2

IdentifierTypeStateIssuer
4917956OtherOTHER ID NUMBER
6003529MedicaidWA

Other names 1

  • SUPER 1 PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080911000092 WA Part B Supplier - Mass Immunization (Roster Biller Only) 9830265131 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spokane, WA; Yakima, WA; Spokane Valley, WA; Ridgefield, WA; Ellensburg, WA; Colville, WA
O20100930039817 WA DME Supplier - PharmacyDME Supplier - Grocery Store 9830265131 Practice locations: Ellensburg, WA

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Rosauers Pharmacy 1020 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

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": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1952399388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992099000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E MOUNTAIN VIEW AVE",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263771",
            "telephone_number": "509-962-7777",
            "fax_number": "509-962-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSAUERS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "PHILIPPS",
        "authorized_official_first_name": "JEFFRY",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "509-326-8900",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "262010403851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4917956",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003529",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER 1 PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellensburg, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.