Organization
HEARTLAND PHARMACY - BOISE
Active
Other names
Heartland Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER SHORTSLEEVE (CORPORATE DME SUPPORT SPECIALIST)
(208) 552-7677
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
183500000X
Pharmacist
1680CP
ID
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1679LS
ID
333600000X
Pharmacy
1680CP
ID
3336L0003X
Long Term Care Pharmacy
1680CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500600675
—
OR
01
—
805126600
MEDICAID DME
ID
05
—
805127900
—
ID
Enumeration date
12/21/2005
Last updated
01/04/2021
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