Eastgate Drug

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

EASTGATE DRUG

Practice address

3250 E 17TH St
Ammon, ID 83406-6758

Phone

(208) 522-1243

Fax

(208) 523-3780

NPI assigned

Jul 11, 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 2

Addresses

Other identifiers 1

Other names 1

• EASTGATE 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 Inc

  • Community/Retail Pharmacy
  • Idaho Falls, ID
  • NPI 1487739611
  NPD tax ID

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1609800937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 E 17TH ST",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 E 17TH ST",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066758",
            "telephone_number": "208-522-1243",
            "fax_number": "208-523-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2025-09-11",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "ID",
            "license": "1010CP",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1301073",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTGATE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lauren Ellis, BS
• Alyson Carol Elsethagen, MS CCC SLP

• Community/Retail Pharmacy in Ammon, ID
• Providers in Ammon, 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 Sep 11, 2025; 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.