<Unavail>

LBN: Medicine Man Pharmacy Inc
<Unavail> is an health care organization with primary practice located at 1114 W Ironwood Dr , Coeur D Alene ID 83814-2605. 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 Pharmacy Inc can be contacted via phone (208) 666-2502, or through Jorgensen, Brian via phone (208) 666-2502.

Contact Information

Primary practice address
1114 W Ironwood Dr Coeur D Alene ID 83814-2605
Phone: (208) 666-2502
Fax: (208) 667-5921
Website:
Map and Directions
Authorized official contact:
Name: Jorgensen, Brian RPH
Phone: (208) 666-2502

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 657RP Idaho

Profile Details

NPI number 1750493698
LBN Legal business name Medicine Man Pharmacy Inc
DBA Doing business as <Unavail>
Authorized official Jorgensen, Brian RPH
Entity Organization
Organization subpart 1 No
Enumeration date Aug 31st, 2006
Last updated Jul 1st, 2013 - about 13 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 1750493698 NPPES
Idaho MEDICAID 002541100
Idaho MEDICAID 002541200
Idaho Other 2020458

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