Jack Arthur Helgeson, RPH
Individual provider Active NPI Pharmacist · Payette, ID
NPI 1972890366 · NPPES record last updated Jul 6, 2011
Key facts
- NPI
- 1972890366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P5317 (ID)
- Practice address
- 405 S Main St
Payette, ID 83661-3317 - Phone
- (208) 642-9331
- Fax
- (208) 642-1550
- NPI assigned
- Jul 6, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P5317 | ID | MD | Pharmacist |
| RPH0008024 | OR | MD | Pharmacist |
| PH00009915 | WA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P5317 | ID | Yes |
| Pharmacist | 183500000X | PH00009915 | WA | |
| Pharmacist | 183500000X | RPH0008024 | OR |
Addresses
Primary practice location
405 S Main St
Payette, ID 83661-3317
Mailing address
405 S 8TH St
Payette, ID 83661
Phone (208) 642-9331
Other providers in Payette, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.