{"npi":"1750498044","type":"NPI-2","status":"active","name":{"display":"Marketime Drug Of Moscow INC","other":[],"organization_name":"MARKETIME DRUG OF MOSCOW INC","authorised_official":"Erik Nelson"},"specialty":{"primary_taxonomy":"333600000X","primary_taxonomy_description":"Pharmacy","slug":"pharmacy","schema_org_specialty":null,"all":[{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":false,"state":null,"license":null},{"code":"3336L0003X","description":"Long Term Care Pharmacy","primary":false,"state":null,"license":null},{"code":"333600000X","description":"Pharmacy","primary":true,"state":"ID","license":"217CP"}]},"addresses":[{"purpose":"LOCATION","street_1":"872 TROY RD STE 120","city":"MOSCOW","state":"ID","postal_code":"838435037","country_code":"US","phone":"2088827541","fax":"2088834716"},{"purpose":"MAILING","street_1":"872 TROY RD STE 120","city":"MOSCOW","state":"ID","postal_code":"838435037","country_code":"US","phone":"2088827541","fax":"2088834716"}],"license":{"state":"ID","number":"217CP"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"0023395","state":"ID","issuer":null},{"type_code":"01","label":"Other","value":"0023396","state":"ID","issuer":"MEDICAID DME"},{"type_code":"01","label":"Other","value":"6021422","state":"WA","issuer":"MEDICAID"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20190524002398","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"ID","pac_id":"5890038392"}]},"enumeration_date":"2006-08-24","last_updated":"2021-01-04","_meta":{"source":"NPPES","snapshot_date":"2021-01-04","doc_url":"https://findmynpi.com/api"}}