Medicine Man Southwest Pharmacy

LBN: Medicine Man West Llc
Medicine Man Southwest Pharmacy is an health care organization with primary practice located at 805 E Polston Ave , Post Falls ID 83854-6044. 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 West Llc can be contacted via phone (208) 777-7732, or through Smith, Donald via phone (208) 777-7732.

Contact Information

Primary practice address
805 E Polston Ave Post Falls ID 83854-6044
Phone: (208) 777-7732
Fax: (208) 777-0201
Website:
Map and Directions
Authorized official contact:
Name: Smith, Donald
Phone: (208) 777-7732

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 1114RP Idaho

Profile Details

NPI number 1982778403
LBN Legal business name Medicine Man West Llc
DBA Doing business as Medicine Man Southwest Pharmacy
Authorized official Smith, Donald
Entity Organization
Organization subpart 1 No
Enumeration date Nov 17th, 2006
Last updated Sep 14th, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982778403 NPPES
Idaho MEDICAID 002599500
Idaho Other 2021075

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