# GEMSTATE PHARMACY GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MediCap LTC Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053742577
- **Authorized official:** BLAIR WHITNEY (GREFFIER)
- **Authorized official phone:** (360) 543-7376

## Contact information

- **Practice address:** 800 S INDUSTRY WAY STE 330, MERIDIAN, ID 83642-3598
- **Practice address phone:** (208) 287-3733
- **Practice address fax:** (208) 258-6756
- **Mailing address:** 851 COHO WAY, SUITE 312, BELLINGHAM, WA 98225-2067
- **Mailing address phone:** (360) 685-4270
- **Mailing address fax:** (360) 205-7504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 40843LS | ID | Yes |

## Other

- **Enumeration date:** 12/09/2013
- **Last updated:** 09/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1053742577 | — | ID |
| 01 | — | 2157649 | PK | — |