Organization
HALCYON RX INC
Active
Other names
MEDICINE MAN LIBERTY LAKE
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN AMINI RPH (OWNER AND PHARMACIST)
(509) 755-3333
Entity
Organization
Contact information
Practice address
23801 E APPLEWAY AVE, STE 260B, LIBERTY LAKE, WA 99019-9687
(509) 755-3333
(509) 755-3337
Mailing address
23801 E APPLEWAY AVE, STE 260B, LIBERTY LAKE, WA 99019-9687
(509) 755-3333
(509) 755-3337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
FL0341254
WA
3336C0004X
Compounding Pharmacy
FL0341254
WA
3336L0003X
Long Term Care Pharmacy
Primary
FL0341254
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4931463
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
6024178
—
WA
Enumeration date
09/12/2006
Last updated
02/12/2008
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