Organization
MEDICINE MAN WEST LLC
Active
Other names
MEDICINE MAN SOUTHWEST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD SMITH (OWNER)
(208) 777-7732
Entity
Organization
Contact information
Practice address
805 E POLSTON AVE, POST FALLS, ID 83854-6044
(208) 777-7732
(208) 777-0201
Mailing address
805 E POLSTON AVE, POST FALLS, ID 83854-6044
(208) 777-7732
(208) 777-0201
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1114RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002599500
—
ID
01
—
2021075
PK
—
Enumeration date
11/17/2006
Last updated
09/14/2016
Update your record
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