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Khaled Eldemerdash , RPH

Pharmacist β€’ Boise, ID

Active NPI 1568206423 Individual Practitioner Male Practitioner
Practice location in NPPES

1220 S Vista Ave Ste A
Boise, ID 837052530

Call 8164052406 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

1220 S Vista Ave Ste A

Boise, ID 837052530

Telephone 8164052406
Organization at the Same NPPES Address or Phone
Weport Medical Pharmacy Facility NPI 1386599371

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2024

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Boise and Idaho

482 active clinicians are listed under Pharmacist with a practice address in Boise, ID (1,764 in Idaho).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Boise

0% of these 482 clinicians have the CMS telehealth indicator.

0% of these 482 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2026-03-28
Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

License # reported to NPPES CA 89376

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Pharmacist

NUCC Taxonomy Code: 183500000X

License # reported to NPPES ID 9561972

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Idaho State Medical Licensing Board.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
πŸ“
Updated Practice Location March 28, 2026

Registered at 1220 S VISTA AVE STE A, BOISE, ID 837052530 (Tel: 8164052406)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 28, 2026

Pharmacist (license number reported to NPPES: ID 9561972)

πŸ“
Updated Practice Location August 29, 2024

Registered at 222 W 39TH AVE, SAN MATEO, CA 944034364 (Tel: 6505732222)

βœ…
NPI Profile Active June 24, 2024

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) June 24, 2024

Registered at 1600 EUREKA RD, ROSEVILLE, CA 956613027 (Tel: 9167844000)

πŸ“
Business Mailing Address (Initial Record) June 24, 2024

Registered at PO BOX 934, CAMARILLO, CA 930110934

πŸ‘€
Provider Name / Credentials (Initial Record) June 24, 2024

Recorded as KHALED ELDEMERDASH, RPH

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) June 24, 2024

Pharmacist (license number reported to NPPES: CA 89376)

🟒
Initial NPI Registration & Enumeration June 24, 2024

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1568206423
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 24, 2024
Last Update: March 28, 2026
Sole Proprietor: Yes

Other Pharmacists in Boise

All Pharmacists in Boise

Mailing Address

Po Box 934

Camarillo, CA 930110934

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.