Medicine Man Athol Pharmacy

LBN: Medicine Man North Pharmacy Inc
Medicine Man Athol Pharmacy is an health care organization with primary practice located at 30585 N Roberts Rd , Hayden ID 83835. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Medicine Man North Pharmacy Inc can be contacted via phone (208) 683-1309, or through Kreider, Korey E via phone (208) 660-3938.

Contact Information

Primary practice address
30585 N Roberts Rd Hayden ID 83835
Phone: (208) 683-1309
Fax: (208) 683-1315
Website:
Map and Directions
Authorized official contact:
Name: Kreider, Korey E PHARMD
Phone: (208) 660-3938

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 47570RP Idaho

Profile Details

NPI number 1851894380
LBN Legal business name Medicine Man North Pharmacy Inc
DBA Doing business as Medicine Man Athol Pharmacy
Authorized official Kreider, Korey E PHARMD
Entity Organization
Organization subpart 1 No
Enumeration date Mar 11th, 2018
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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851894380 NPPES
Idaho MEDICAID 1851894380
Idaho Other 2176449

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