Organization
EASTGATE DRUG
Active
Other names
EASTGATE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
COREY SMITH (PRESIDENT)
(208) 522-1243
Entity
Organization
Contact information
Practice address
3250 E 17TH ST, AMMON, ID 83406-6758
(208) 522-1243
(208) 523-3780
Mailing address
3250 E 17TH ST, AMMON, ID 83406-6758
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
1010CP
ID
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1301073
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/11/2006
Last updated
09/11/2025
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