Healthcare Provider Details

I. General information

NPI: 1417333501
Provider Name (Legal Business Name): GOODING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MAIN ST
GOODING ID
83330-1304
US

IV. Provider business mailing address

445 MAIN ST
GOODING ID
83330-1304
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-4000
  • Fax: 208-934-8899
Mailing address:
  • Phone: 208-934-4000
  • Fax: 208-934-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number40040RP
License Number StateID

VIII. Authorized Official

Name: JASON READING
Title or Position: PRESIDENT
Credential: PHARM-D
Phone: 208-681-5897