Byu Id Student HLTH CNTR Pchy

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

License

614RP Issued in ID

Legal business name

BYU ID STUDENT HLTH CNTR PCHY

Doing business as

BYU-IDAHO STUDENT HEALTH CENTER PHARMACY

Practice address

179 Student HLTH Ctr
Rexburg, ID 83460-0001

Phone

(208) 496-9330

Fax

(208) 496-9343

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Shawn Andreasen, PHARMD RPH

Title

Pchy Dir

Phone

(208) 496-9330

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• BYU-IDAHO STUDENT HEALTH CENTER PHARMACY Doing business as

Tax ID family

Byu Id Student HLTH CNTR Pchy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Byu Idaho Student Health Center

  • Clinic/Center
  • Rexburg, ID
  • NPI 1538347034
  NPD tax ID

Locations

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1992726962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 STUDENT HLTH CTR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834600001",
            "telephone_number": "208-496-9330",
            "fax_number": "208-496-9343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 STUDENT HLTH CTR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834600001",
            "telephone_number": "208-496-9330",
            "fax_number": "208-496-9343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BYU ID STUDENT HLTH CNTR PCHY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "ANDREASEN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PCHY DIR",
        "authorized_official_telephone_number": "208-496-9330",
        "authorized_official_credential": "PHARMD RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "ID",
            "license": "614RP",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020561",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BYU-IDAHO STUDENT HEALTH CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tiffany Nudcha Burgess
• Burke Non-Emergency Medical Transport, LLC
• Jon Burnham, LCSW
• Marisela Butler, BI
• Melissa Byington
• Byu Idaho Student Health Center
• Bryce Campbell
• Nora Campbell
• Canyon View Eyecare PLLC
• Megan Carlson

• Clinic Pharmacy in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Clinic Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.