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Organization
MARKETIME DRUG OF MOSCOW INC
Active
Organization
MARKETIME DRUG OF MOSCOW INC
Active
Other names
Marketime Drug
Organization subpart
No
Provider details
NPI number
Authorized official
ERIK JAMES NELSON PHARMD (PRESIDENT)
(509) 455-9345
Entity
Organization
Contact information
Practice address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
(208) 883-4716
Mailing address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
(208) 883-4716
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
217CP
ID
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023395
—
ID
01
—
0023396
MEDICAID DME
ID
01
—
6021422
MEDICAID
WA
Enumeration date
08/24/2006
Last updated
01/04/2021
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