Eastgate Drug Store

LBN: Eastgate Drug
Eastgate Drug Store is an health care organization with primary practice located at 3250 E 17Th St , Ammon ID 83406-6758. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Eastgate Drug can be contacted via phone (208) 522-1243, or through Smith, Corey via phone (208) 522-1243.

Contact Information

Primary practice address
3250 E 17Th St Ammon ID 83406-6758
Phone: (208) 522-1243
Fax: (208) 523-3780
Website:
Map and Directions
Authorized official contact:
Name: Smith, Corey
Phone: (208) 522-1243

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 1010CP Idaho
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1609800937
LBN Legal business name Eastgate Drug
DBA Doing business as Eastgate Drug Store
Authorized official Smith, Corey
Entity Organization
Organization subpart 1 No
Enumeration date Jul 11th, 2006
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609800937 NPPES
Other 1301073 OTHER ID NUMBER-COMMERCIAL NUMBER

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