Medicine Man West Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

719CP Issued in ID

Legal business name

MEDICINE MAN WEST PHARMACY LLC

Doing business as

MEDICINE MAN WEST PHARMACY

Practice address

802 E Medical CT
Post Falls, ID 83854-7298

Phone

(208) 773-3566

Fax

(208) 777-8239

NPI assigned

Nov 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donald Smith

Title

Owner

Phone

(208) 773-3566

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• MEDICINE MAN WEST PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1124193487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 E MEDICAL CT",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838547298",
            "telephone_number": "208-773-3566",
            "fax_number": "208-777-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 E MEDICAL CT",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838547298",
            "telephone_number": "208-773-3566",
            "fax_number": "208-777-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN WEST PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-773-3566"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "719CP",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002599400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "20002785",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1304411",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MAN WEST PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jobeth McKoon, OTR/L
• Danelle McLachlan, MOT/L
• Alfred Meckel, LMSW
• Medicine Man Compounding Center LLC
• Medicine Man West LLC
• Shaelynn Meek, ATC
• Michelle Rae Mefford
• Tamara Annette Meinecke
• Ronald Eugene Mendenhall, D.D.S.
• Bethany Meredith, MA

• Community/Retail Pharmacy in Post Falls, ID
• Providers in Post Falls, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.