Organization
EASTGATE DRUG INC
Active
Other names
WESTGATE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
COREY SMITH (PRESIDENT)
(208) 522-1243
Entity
Organization
Contact information
Practice address
1850 W BROADWAY, IDAHO FALLS, ID 83402
(208) 522-4655
(208) 522-6670
Mailing address
1850 W BROADWAY, IDAHO FALLS, ID 83402
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2125CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307734
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/26/2006
Last updated
08/22/2020
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