Organization
MEDICINE MAN WEST LLC
Active
Other names
MEDICINE MAN RATHDRUM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DUNCAN BELL (MANAGER)
(208) 687-5717
Entity
Organization
Contact information
Practice address
15837 N WESTWOOD DR, RATHDRUM, ID 83858-6432
(208) 687-5717
(208) 687-9387
Mailing address
802 E MEDICAL CT, POST FALLS, ID 83854-7298
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1513RP
ID
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021740
PK
—
05
—
805797600
—
ID
Enumeration date
03/29/2006
Last updated
06/26/2014
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