Organization
MARKETIME DRUG OF MOSCOW INC
Active
Other names
Marketime Drug
Organization subpart
No
Provider details
NPI number
Authorized official
ERIK JAMES NELSON PHARMD (PRESIDENT)
(509) 455-9345
Entity
Organization
Contact information
Practice address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
(208) 883-4716
Mailing address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
(208) 883-4716
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
217CP
ID
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023395
—
ID
01
—
0023396
MEDICAID DME
ID
01
—
6021422
MEDICAID
WA
Enumeration date
08/24/2006
Last updated
01/04/2021
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