Organization
HEARTLAND PHARMACY - IDAHO FALLS
Active
Organization
HEARTLAND PHARMACY - IDAHO FALLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REECE CHRISTENSEN (CEO PRESIDENT)
(208) 497-3575
Entity
Organization
Contact information
Practice address
3250 E 17TH ST, AMMON, ID 83406-6758
(208) 552-7677
(208) 552-2103
Mailing address
1790 SABIN DR, AMMON, ID 83406-6747
(208) 497-3575
(208) 552-2103
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1624LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0562258
—
MT
05
—
1548423338
—
UT
05
—
2038144
—
WA
05
—
806141400
—
ID
Enumeration date
07/02/2008
Last updated
11/13/2020
Update your record
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