Active NPI
Benjamin Jesse Cook, PHARMD
- Pharmacist
- Garden City, ID
National Provider Identifier
1992094304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6104
- Practice address
- 5425 W Chinden Blvd
Garden City, ID 83714-1468 - Phone
- (208) 323-7036
- Fax
- (208) 323-7036
- NPI assigned
- Apr 6, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P6104 | ID | Primary |
Addresses
Primary practice location
5425 W Chinden Blvd
Garden City, ID 83714-1468
Mailing address
5425 W Chinden Blvd
Garden City, ID 83714-1468
Phone (208) 323-7036
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CS12296 | Other | ID | IDAHO CONTROLLED SUBSTANCE REGISTRATION |
| P6104 | Other | ID | IDAHO PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6104 | ID | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc | Past | Accepting new patients | |
| Fred Meyer Stores Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Fred Meyer Pharmacy
- Community/Retail Pharmacy
- Garden City, ID
- NPI 1316983224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302048000000",
"number": "1992094304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5425 W CHINDEN BLVD",
"city": "GARDEN CITY",
"state": "ID",
"postal_code": "837141468",
"telephone_number": "208-323-7036",
"fax_number": "208-323-7036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5425 W CHINDEN BLVD",
"city": "GARDEN CITY",
"state": "ID",
"postal_code": "837141468",
"telephone_number": "208-323-7036",
"fax_number": "208-323-7036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "BENJAMIN",
"middle_name": "JESSE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-06",
"last_updated": "2011-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO CONTROLLED SUBSTANCE REGISTRATION",
"identifier": "CS12296",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO PHARMACIST LICENSE",
"identifier": "P6104",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.