Organization
MEDICINE MAN WEST PHARMACY LLC
Active
Other names
MEDICINE MAN WEST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD SMITH (OWNER)
(208) 773-3566
Entity
Organization
Contact information
Practice address
802 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-3566
(208) 777-8239
Mailing address
802 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-3566
(208) 777-8239
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
719CP
ID
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002599400
—
ID
01
—
1304411
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
20002785
MEDICARE PART B
ID
Enumeration date
11/22/2006
Last updated
01/19/2024
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