NPIMap

Organization Active NPI

Heartland Pharmacy - Boise

Doing business as Heartland LTC Pharmacy

  • Long Term Care Pharmacy
  • Boise, ID
National Provider Identifier
1710056445
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
1679LS Issued in ID
Legal business name
HEARTLAND PHARMACY - BOISE
Doing business as
Heartland LTC Pharmacy
Practice address
8455 W Emerald St
Boise, ID 83704-8306
Phone
(208) 323-0067
Fax
(208) 323-5954
NPI assigned
Nov 7, 2006
Last updated
Nov 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

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

Authorized official

Name
Andrea Ferguson
Title
Executive Assistant
Phone
(208) 497-3575

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Long Term Care Pharmacy 3336L0003X 1679LS ID Primary

Addresses

Primary practice location

8455 W Emerald St
Boise, ID 83704-8306

Mailing address

1790 Sabin Dr
Ammon, ID 83406-6747
Phone (208) 497-3575

Other identifiers 2

IdentifierTypeStateIssuer
2021934OtherPK
805127900MedicaidID

Other names 1

  • HEARTLAND LTC PHARMACY Doing business as

National Provider Directory

National Provider Directory

Member organizations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1710056445",
    "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": "8455 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048306",
            "telephone_number": "208-323-0067",
            "fax_number": "208-323-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PHARMACY - BOISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "208-497-3575"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "ID",
            "license": "1679LS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2021934",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805127900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEARTLAND LTC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HEARTLAND LTC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.