Organization
MOUNTAIN CARE PHARMACY IDAHO
Active
Other names
Mountain Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JARED STONG (OWNER)
(801) 747-7191
Entity
Organization
Contact information
Practice address
1753 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 932-1260
(208) 523-2330
Mailing address
1030 BELLWOOD LN, MURRAY, UT 84123-4494
(801) 747-7191
(801) 747-7192
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
18014LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308661
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/10/2012
Last updated
02/10/2012
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