Provider Demographics
NPI:1821653890
Name:GOODING PHARMACY INC
Entity Type:Organization
Organization Name:GOODING PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:READING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-681-5897
Mailing Address - Street 1:405 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5167
Mailing Address - Country:US
Mailing Address - Phone:208-681-5897
Mailing Address - Fax:
Practice Address - Street 1:631 FROGS LNDG
Practice Address - Street 2:
Practice Address - City:HAGERMAN
Practice Address - State:ID
Practice Address - Zip Code:83332-5034
Practice Address - Country:US
Practice Address - Phone:208-254-5466
Practice Address - Fax:208-254-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy