Medicine Man Pharmacy Inc
LBN: Medicine Man Pharmacy Inc
Medicine Man Pharmacy Inc is an health care organization with primary practice located at 1114 W Ironwood Dr , Coeur D Alene ID 83814-2605. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Medicine Man Pharmacy Inc can be contacted via phone (208) 666-2502, or through Jorgensen, Brian via phone (208) 666-2502.
Contact Information
Primary practice address
1114 W Ironwood Dr
Coeur D Alene ID 83814-2605
Phone: (208) 666-2502
Fax: (208) 667-5921
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 657RP | Idaho |
Profile Details
| NPI number | 1750493698 |
|---|---|
| LBN Legal business name | Medicine Man Pharmacy Inc |
| DBA Doing business as | Medicine Man Pharmacy Inc |
| Authorized official | Jorgensen, Brian RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Aug 31st, 2006 |
| Last updated | Jul 1st, 2013 - about 11 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750493698 | NPPES |
| Idaho | MEDICAID | 002541100 | |
| Idaho | MEDICAID | 002541200 | |
| Idaho | Other | 2020458 |
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