Medicine Man Bonners Ferry Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

37603RP Issued in ID

Legal business name

MEDICINE MAN BONNERS FERRY PHARMACY LLC

Doing business as

Medicine Man Bonners Ferry Pharmacy

Practice address

6452 Main St
Bonners Ferry, ID 83805-8520

Phone

(208) 267-4021

Fax

(208) 267-4024

NPI assigned

Jun 19, 2012

Organization subpart

No

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

Authorized official

Name

Aimee StuermerNPI 1063823052

Title

Co-Owner

Phone

(208) 627-8861

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Medicine Man Bonners Ferry Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aimee Stuermer, PHARM.D., RPH

  • Pharmacist
  • Bonners Ferry, ID
  • NPI 1063823052
  NPD Authorized official
• Shane Stuermer, PHARM.D., RPH

  • Pharmacist
  • Bonners Ferry, ID
  • NPI 1780095778
  NPD
• John Willis

  • Pharmacist
  • Bonners Ferry, ID
  • NPI 1619393493
  NPD (past)

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1578826178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 MAIN ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058520",
            "telephone_number": "208-267-4021",
            "fax_number": "208-267-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6452 MAIN ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838058520",
            "telephone_number": "208-267-4021",
            "fax_number": "208-267-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN BONNERS FERRY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "STUERMER",
        "authorized_official_first_name": "AIMEE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "208-627-8861"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "37603RP",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578826178",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578826178",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150407",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Man Bonners Ferry Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssa Matthews, OTR/L
• Wendolyn E McClintock, R.D., L.D.
• Jeffrey McDowell, LCPC
• David Lynn McIntosh, DDS
• Ashlie Mead
• Karen Ann Meeker, R.P.T.
• Rachel Meiland-Webster, LCSW
• Erma N Miller, LMT
• Stephenie Miller
• Edward Gregory Moellmer, MD

• Community/Retail Pharmacy in Bonners Ferry, ID
• Providers in Bonners Ferry, 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 May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.