Organization
INTERLAKE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM BROWN RPH (PHARMACIST/OWNER)
(208) 664-6664
Entity
Organization
Contact information
Practice address
700 W IRONWOOD DR, SUITE 159, COEUR D ALENE, ID 83814-2656
(208) 664-6664
(208) 664-8527
Mailing address
700 W IRONWOOD DR, SUITE 159, COEUR D ALENE, ID 83814-2656
(208) 664-6664
(208) 664-8527
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
782CP
ID
332B00000X
Durable Medical Equipment & Medical Supplies
782CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001679200
—
ID
05
—
002627900
—
ID
Enumeration date
02/10/2006
Last updated
09/14/2015
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