Medicine Man North Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

847RP Issued in ID

Legal business name

MEDICINE MAN NORTH PHARMACY INC

Practice address

305 W Kathleen Ave
Coeur D Alene, ID 83815-8338

Phone

(208) 765-2268

Fax

(208) 765-3540

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Korey E Kreider, PHARMD

Title

C00

Phone

(206) 660-3938

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICINE MAN NORTH PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medicine Man North Pharmacy Inc

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1023179892

  O20081220000110

  Same enrollment
• Medicine Man North Pharmacy Inc

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1851894380

  O20081220000110

  Same enrollment

Locations

Practitioners 5

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

• Shawna Lynn Daniels, RPH

  • Pharmacist
  • Hayden, ID
  • NPI 1215401922
  NPD (past)
• Jason Head

  • Pharmacist
  • Hayden, ID
  • NPI 1366868044
  NPD (past)
• Chax Brandon Peterson, PHARM. D.

  • Pharmacist
  • Hayden, ID
  • NPI 1407272065
  NPD (past)
• Jace Devon Rogers, PHARMD

  • Pharmacist
  • Hayden, ID
  • NPI 1508584624
  NPD (past)
• Brian S Stewart, PHARMD

  • Pharmacist
  • Hayden, ID
  • NPI 1215463690
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1649333261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1706",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838351706",
            "telephone_number": "208-765-2268",
            "fax_number": "208-765-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W KATHLEEN AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158338",
            "telephone_number": "208-765-2268",
            "fax_number": "208-765-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN NORTH PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "KREIDER",
        "authorized_official_first_name": "KOREY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "C00",
        "authorized_official_telephone_number": "206-660-3938",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "847RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649333261",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020848",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MAN NORTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICINE MAN NORTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abigail McWilliams
• Mark Mead, DC
• Philip Bruce Meadow, D.O. F.A.C.R.
• Christopher Meadows, MD
• Katelyn Cheyenne Means, DMD
• Medicine Man Pharmacy Inc
• Jeffery Thomas Meech, PSYD, MSCP
• Angela Meerdink, RPH
• Susan Melchiore, MD
• Michael Gerardo Melendez, MD

• All providers in Coeur D Alene, ID
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.