Eastgate Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2125CP Issued in ID

Legal business name

EASTGATE DRUG INC

Practice address

1850 W Broadway
Idaho Falls, ID 83402

Phone

(208) 522-4655

Fax

(208) 522-6670

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Corey Smith

Title

President

Phone

(208) 522-1243

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WESTGATE DRUG STORE Doing business as

Tax ID family

Eastgate Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eastgate Drug

  • Community/Retail Pharmacy
  • Ammon, ID
  • NPI 1609800937
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487739611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 W BROADWAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W BROADWAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83402",
            "telephone_number": "208-522-4655",
            "fax_number": "208-522-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-522-1243"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "2125CP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1307734",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTGATE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eastern Idaho Reg Med Ctr PS, LLC
• Eastern Idaho Regional Medical Center
• Eastern Idaho Regional Medical Center Inpatient Services, LLC
• Eastern Idaho RMC Inpatient Services
• Eastern Idaho Spine Center
• Eastunder Therapy LLC
• Sandi De Eatinger, LCSW
• Colby C Ebanks, PT, DPT
• Ecetera Therapy Clinic
• Amanda Eck, MOTR/L

• Community/Retail Pharmacy in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.