Provider Demographics
NPI:1467105726
Name:OAKSTEAD INFUSION PHARMACY OF IDAHO, LLC
Entity Type:Organization
Organization Name:OAKSTEAD INFUSION PHARMACY OF IDAHO, LLC
Other - Org Name:VITAL CARE OF EASTERN IDAHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-623-8614
Mailing Address - Street 1:2375 E SUNNYSIDE RD STE F2
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8280
Mailing Address - Country:US
Mailing Address - Phone:208-623-8614
Mailing Address - Fax:208-572-7540
Practice Address - Street 1:2375 E SUNNYSIDE RD STE F2
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8280
Practice Address - Country:US
Practice Address - Phone:208-623-8614
Practice Address - Fax:208-572-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy