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Contact Information

HEARTLAND PHARMACY - IDAHO FALLS
3250 E 17TH ST
AMMON, ID83406-6758
 Phone: 208-552-7677
 Fax: 208-552-2098
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for HEARTLAND PHARMACY - IDAHO FALLS

NPI # 1740265420
LBN Legal business name HEARTLAND PHARMACY - IDAHO FALLS
Authorized official ANDREA FERGUSON - (AUTHORIZED OFFICIAL)
Entity Organization
Organization subpart 1 No
Enumeration date 12/14/2005
Last updated 12/14/2020 - About 5 years ago
Identifiers
ID License # 1624LS
ID Medicaid 806143700
MT Medicaid 0212857
UT Medicaid 1740265420
Other 2021757 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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