Organization
HEARTLAND PHARMACY - BOISE
Active
Other names
HEARTLAND LTC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA FERGUSON (EXECUTIVE ASSISTANT)
(208) 497-3575
Entity
Organization
Contact information
Practice address
8455 W EMERALD ST, BOISE, ID 83704-8306
(208) 323-0067
(208) 323-5954
Mailing address
1790 SABIN DR, AMMON, ID 83406-6747
(208) 497-3575
(208) 552-2103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
1679LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021934
PK
—
05
—
805127900
—
ID
Enumeration date
11/07/2006
Last updated
11/13/2020
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