# HEARTLAND PHARMACY - BOISE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HEARTLAND LTC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710056445
- **Authorized official:** ANDREA FERGUSON (EXECUTIVE ASSISTANT)
- **Authorized official phone:** (208) 497-3575

## Contact information

- **Practice address:** 8455 W EMERALD ST, BOISE, ID 83704-8306
- **Practice address phone:** (208) 323-0067
- **Practice address fax:** (208) 323-5954
- **Mailing address:** 1790 SABIN DR, AMMON, ID 83406-6747
- **Mailing address phone:** (208) 497-3575
- **Mailing address fax:** (208) 552-2103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 1679LS | ID | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 11/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2021934 | PK | — |
| 05 | — | 805127900 | — | ID |