Healthcare Provider Details

I. General information

NPI: 1053860767
Provider Name (Legal Business Name): GOODING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 SOUTH BEVERLY STREET
SHOSHONE ID
83352
US

IV. Provider business mailing address

653 S BEVERLY ST
SHOSHONE ID
83352-5121
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-4000
  • Fax: 208-886-2220
Mailing address:
  • Phone: 208-886-2000
  • Fax: 208-886-2220

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 Number43300LS
License Number StateID

VIII. Authorized Official

Name: JASON READING
Title or Position: PRESIDENT
Credential:
Phone: 208-324-3784