NPIMap

Organization Active NPI

Medicine Man Compounding Center LLC

  • Compounding Pharmacy
  • Post Falls, ID
National Provider Identifier
1659907962
Registry record updated Mar 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
Legal business name
MEDICINE MAN COMPOUNDING CENTER LLC
Doing business as
Medicine Man Compounding Center LLC
Practice address
565 N Vest St
Post Falls, ID 83854-7066
Phone
(208) 773-2499
Fax
(208) 773-6309
NPI assigned
Mar 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2020

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

Authorized official

Name
Donald Ray Smith, RPH
Title
Managing Parner
Phone
(208) 661-5199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X Primary

Addresses

Primary practice location

565 N Vest St
Post Falls, ID 83854-7066

Mailing address

565 N Vest St
Post Falls, ID 83854-7066
Phone (208) 773-2499

Other names 1

  • Medicine Man Compounding Center LLC Doing business as

National Provider Directory

National Provider Directory

Locations

565 N Vest St
Post Falls, ID 83854
Phone (208) 773-2499

NPI Registry JSON

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1659907962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 N VEST ST",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838547066",
            "telephone_number": "208-773-2499",
            "fax_number": "208-773-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 N VEST ST",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838547066",
            "telephone_number": "208-773-2499",
            "fax_number": "208-773-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN COMPOUNDING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MANAGING PARNER",
        "authorized_official_telephone_number": "208-661-5199",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Man Compounding Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Post Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.