Interlake Pharmacy Inc

LBN: Interlake Pharmacy Inc
Interlake Pharmacy Inc is an health care organization with primary practice located at 700 W Ironwood Dr Suite 159, Coeur D Alene ID 83814-2656. The organization recently has 2 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist, Suppliers / Durable Medical Equipment & Medical Supplies. Pharmacy Service Providers / Pharmacist is the primary health care specialty. Interlake Pharmacy Inc can be contacted via phone (208) 664-6664, or through Brown, Tim via phone (208) 664-6664.

Contact Information

Primary practice address
700 W Ironwood Dr Suite 159 Coeur D Alene ID 83814-2656
Phone: (208) 664-6664
Fax: (208) 664-8527
Website:
Map and Directions
Authorized official contact:
Name: Brown, Tim RPH
Phone: (208) 664-6664

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 782CP Idaho
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 782CP Idaho

Profile Details

NPI number 1467425249
LBN Legal business name Interlake Pharmacy Inc
DBA Doing business as
Authorized official Brown, Tim RPH
Entity Organization
Organization subpart 1 No
Enumeration date Feb 10th, 2006
Last updated Sep 14th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467425249 NPPES
Idaho MEDICAID 002627900
Idaho MEDICAID 001679200

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