Interlake Pharmacy Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

782CP Issued in ID

Legal business name

INTERLAKE PHARMACY INC

Practice address

700 W Ironwood Dr
Suite 159
Coeur D Alene, ID 83814-2656

Phone

(208) 664-6664

Fax

(208) 664-8527

NPI assigned

Feb 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Tim Brown, RPH

Title

Pharmacist/Owner

Phone

(208) 664-6664

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Sharp, PHARMD

  • Pharmacist
  • Coeur d'Alene, ID
  • NPI 1609220391
  NPD (past)

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442188800000",
    "number": "1467425249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "SUITE 159",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-664-6664",
            "fax_number": "208-664-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR",
            "address_2": "SUITE 159",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142656",
            "telephone_number": "208-664-6664",
            "fax_number": "208-664-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERLAKE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2015-09-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "208-664-6664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "782CP",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "782CP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002627900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001679200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.