Mountain Care Pharmacy Idaho

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

18014LS Issued in ID

Legal business name

MOUNTAIN CARE PHARMACY IDAHO

Doing business as

Mountain Care Pharmacy

Practice address

1753 W Broadway St
Idaho Falls, ID 83402-3045

Phone

(208) 932-1260

Fax

(208) 523-2330

NPI assigned

Feb 10, 2012

Organization subpart

No

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

Authorized official

Name

Jared Stong

Title

Owner

Phone

(801) 747-7191

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mountain Care Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1588937395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 BELLWOOD LN",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841234494",
            "telephone_number": "801-747-7191",
            "fax_number": "801-747-7192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1753 W BROADWAY ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023045",
            "telephone_number": "208-932-1260",
            "fax_number": "208-523-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN CARE PHARMACY IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "STONG",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-747-7191"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "ID",
            "license": "18014LS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1308661",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Care Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renee Marie Moss, CMT
• Sheila Moss, FNP-C
• Moulton Periodontics, PLLC (Ridge Crest Periodontics)
• Barbara J Moulton
• Ethan D. Moulton, D.D.S.,M.S.
• Mountain Crest Foot and Ankle PA
• Mountain Falls Medical LLC
• Mountain Falls Quick Care
• Mountain River Mental Health
• Mountain River Mental Health

• Long Term Care Pharmacy in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Long Term Care Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; 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.