Organization
HALCYON RX INC
Active
Other names
MEDICINE MAN LIBERTY LAKE
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN AMINI RPH (PRESIDENT)
(509) 255-7611
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
23801 E APPLEWAY AVE, STE 260, LIBERTY LAKE, WA 99019-9687
(509) 255-7611
(509) 755-3337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.00059100
WA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4928593
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/10/2006
Last updated
11/27/2012
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