Organization
MEDICINE MAN BONNERS FERRY PHARMACY LLC
Active
Other names
Medicine Man Bonners Ferry Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AIMEE STUERMER (CO-OWNER)
(208) 627-8861
Entity
Organization
Contact information
Practice address
6452 MAIN ST, BONNERS FERRY, ID 83805-8520
(208) 267-4021
(208) 267-4024
Mailing address
6452 MAIN ST, BONNERS FERRY, ID 83805-8520
(208) 267-4021
(208) 267-4024
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
37603RP
ID
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578826178
—
ID
05
—
1578826178
—
MT
01
—
2150407
PK
—
Enumeration date
06/19/2012
Last updated
05/23/2024
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