# HEARTLAND PHARMACY - IDAHO FALLS

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

## Provider details

- **NPI number:** 1740265420
- **Authorized official:** ANDREA FERGUSON (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (208) 497-3575

## Contact information

- **Practice address:** 3250 E 17TH ST, AMMON, ID 83406-6758
- **Practice address phone:** (208) 552-7677
- **Practice address fax:** (208) 552-2098
- **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 | 1624LS | ID | Yes |

## Other

- **Enumeration date:** 12/14/2005
- **Last updated:** 12/14/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0212857 | — | MT |
| 05 | — | 1740265420 | — | UT |
| 01 | — | 2021757 | PK | — |
| 05 | — | 806143700 | — | ID |