NPIMap

Organization Active NPI

Maag Prescription Center LLC

Doing business as Maag Prescription & Medical Supply

  • Community/Retail Pharmacy
  • Pocatello, ID
National Provider Identifier
1972633915
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
526CP Issued in ID
Legal business name
MAAG PRESCRIPTION CENTER LLC
Doing business as
Maag Prescription & Medical Supply
Practice address
333 W. Center St.
Pocatello, ID 83204
Phone
(208) 233-2063
Fax
(208) 233-6158
NPI assigned
Mar 7, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Kathleen Carol Maag
Title
Cfo/Owner
Phone
(208) 233-2063

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 526CP ID Primary
Compounding Pharmacy 3336C0004X 526CP ID

Addresses

Primary practice location

333 W. Center St.
Pocatello, ID 83204

Mailing address

PO Box 115
Pocatello, ID 83204-0115
Phone (208) 233-2063

Other identifiers 2

IdentifierTypeStateIssuer
526CPOtherIDST. BOARD OF PHARMACY #
002488900MedicaidID

Other names 1

  • Maag Prescription & Medical Supply Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160126002566 ID Part B Supplier - Mass Immunization (Roster Biller Only) 7315156643 Practice locations: Pocatello, ID

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Maag Prescription Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

333 W Center St
Pocatello, ID 83204
Phone (208) 233-2063

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1972633915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 115",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832040115",
            "telephone_number": "208-233-2063",
            "fax_number": "208-233-6158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W. CENTER ST.",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83204",
            "telephone_number": "208-233-2063",
            "fax_number": "208-233-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAAG PRESCRIPTION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MAAG",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "CFO/OWNER",
        "authorized_official_telephone_number": "208-233-2063"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "526CP",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "ID",
            "license": "526CP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST. BOARD OF PHARMACY #",
            "identifier": "526CP",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002488900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maag Prescription & Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.