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Organization
MOUNTAIN CARE PHARMACY IDAHO
Active
Organization
MOUNTAIN CARE PHARMACY IDAHO
Active
Other names
Mountain Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JARED STONG (OWNER)
(801) 747-7191
Entity
Organization
Contact information
Practice address
1753 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 932-1260
(208) 523-2330
Mailing address
1030 BELLWOOD LN, MURRAY, UT 84123-4494
(801) 747-7191
(801) 747-7192
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
18014LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308661
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/10/2012
Last updated
02/10/2012
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