Medicine Man Prairie Pharmacy
LBN: Medicine Man North Pharmacy Inc
Medicine Man Prairie Pharmacy is an health care organization with primary practice located at 8093 N Cornerstone Dr , Hayden ID 83835-8753. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Medicine Man North Pharmacy Inc can be contacted via phone (208) 762-9355, or through Kreider, Korey E via phone (208) 660-3938.
Contact Information
Primary practice address
8093 N Cornerstone Dr
Hayden ID 83835-8753
Phone: (208) 762-9355
Fax: (208) 762-9198
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 1308RP | Idaho |
| Suppliers / Compounding Pharmacy | 3336C0004X |
Profile Details
| NPI number | 1023179892 |
|---|---|
| LBN Legal business name | Medicine Man North Pharmacy Inc |
| DBA Doing business as | Medicine Man Prairie Pharmacy |
| Authorized official | Kreider, Korey E PHARMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 13th, 2006 |
| Last updated | Jun 3rd, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023179892 | NPPES |
| Other | 2021452 | PK | |
| MEDICAID | 1023179892 | PK |
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