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Organization
HEARTLAND PHARMACY - IDAHO FALLS
Active
Organization
HEARTLAND PHARMACY - IDAHO FALLS
Active
Other names
HEARTLAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA FERGUSON (AUTHORIZED OFFICIAL)
(208) 497-3575
Entity
Organization
Contact information
Practice address
3250 E 17TH ST, AMMON, ID 83406-6758
(208) 552-7677
(208) 552-2098
Mailing address
1790 SABIN DR, AMMON, ID 83406-6747
(208) 497-3575
(208) 552-2103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
1624LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0212857
—
MT
05
—
1740265420
—
UT
01
—
2021757
PK
—
05
—
806143700
—
ID
Enumeration date
12/14/2005
Last updated
12/14/2020
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