Guardian Pharmacy of Idaho Falls, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GUARDIAN PHARMACY OF IDAHO FALLS, LLC

Doing business as

Heartland Pharmacy - Idaho Falls

Practice address

3250 E 17TH St
Ammon, ID 83406-6758

Phone

(208) 552-7677

Fax

(208) 552-2098

NPI assigned

Apr 1, 2024

Last updated

Aug 2, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Reece Christensen

Title

President/Owner

Phone

(208) 497-3575

Specialties & licenses 4

Addresses

Other names 1

• Heartland Pharmacy - Idaho Falls Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Guardian Pharmacy of Montana, LLC

  • Long Term Care Pharmacy
  • Missoula, MT
  • NPI 1144186255

  Member Of

  NPD member

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1639920051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 SABIN DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066747",
            "telephone_number": "208-497-3575",
            "fax_number": "208-552-2103"
        },
        {
            "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": "208-552-7677",
            "fax_number": "208-552-2098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF IDAHO FALLS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "REECE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "208-497-3575"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.pharmeaserx.com/",
            "affiliation": "N",
            "endpointDescription": "Health Information Exchange (HIE)",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HIE",
            "address_1": "3250 E 17th St",
            "city": "Ammon",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834066758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Heartland Pharmacy - Idaho Falls",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heartland Pharmacy - Idaho Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jordan Neil Hale, PA-C
• Avery C Hall, PA-C

• Long Term Care Pharmacy in Ammon, ID
• Providers in Ammon, 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 Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.