Organization
MEDICINE MAN COMPOUNDING CENTER LLC
Active
Other names
Medicine Man Compounding Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD RAY SMITH RPH (MANAGING PARNER)
(208) 661-5199
Entity
Organization
Contact information
Practice address
565 N VEST ST, POST FALLS, ID 83854-7066
(208) 773-2499
(208) 773-6309
Mailing address
565 N VEST ST, POST FALLS, ID 83854-7066
(208) 773-2499
(208) 773-6309
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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