# CROSS LTC PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cross Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619306214
- **Authorized official:** MR. BLAKE BUFFAT PHARMD. (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (208) 403-0084

## Contact information

- **Practice address:** 4990 VALENTY RD, SUITE A1, CHUBBUCK, ID 83202-1883
- **Practice address phone:** (208) 403-0084
- **Practice address fax:** (208) 403-0361
- **Mailing address:** PO BOX 2122, IDAHO FALLS, ID 83403-2122
- **Mailing address phone:** (208) 403-0084
- **Mailing address fax:** (208) 403-0361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 33793LS | ID | Yes |

## Other

- **Enumeration date:** 11/04/2013
- **Last updated:** 12/09/2025