Organization
WELL LIFE COMPOUNDING LLC
Active
Other names
Well Life Liberty Lake Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY FOSTER (MEMBER/MANAGER)
(509) 755-3333
Entity
Organization
Contact information
Practice address
23801 E APPLEWAY AVE, STE 260, LIBERTY LAKE, WA 99019-9687
(509) 255-7611
(509) 755-3337
Mailing address
6603 MAIN ST, BONNERS FERRY, ID 83805-8522
(208) 267-4004
(208) 267-7405
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHAR.CF.00059100
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144734
PK
—
Enumeration date
03/17/2014
Last updated
03/17/2014
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