Medicine Man Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

657RP Issued in ID

Legal business name

MEDICINE MAN PHARMACY INC

Doing business as

Medicine Man Pharmacy Inc

Practice address

1114 W Ironwood Dr
Coeur D Alene, ID 83814-2605

Phone

(208) 666-2502

Fax

(208) 667-5921

NPI assigned

Aug 31, 2006

Last updated

Jul 1, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian Jorgensen, RPH

Title

President

Phone

(208) 666-2502

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• MEDICINE MAN PHARMACY INC Doing business as

Locations

Practitioners 2

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.

• Timothy Biediger, RPH

  • Pharmacist
  • Coeur d'Alene, ID
  • NPI 1235531559
  NPD (past)
• Allen Ortmann, RPH

  • Pharmacist
  • Coeur d'Alene, ID
  • NPI 1851687495
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1750493698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142605",
            "telephone_number": "208-666-2502",
            "fax_number": "208-667-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142605",
            "telephone_number": "208-666-2502",
            "fax_number": "208-667-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "JORGENSEN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-666-2502",
        "authorized_official_credential": "RPH"
    },
    "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": "657RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002541200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002541100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020458",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MAN PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• Community/Retail Pharmacy in Coeur d'Alene, ID
• Providers in Coeur d'Alene, 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 Jul 1, 2013; 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.