Halcyon RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHAR.CF.00059100 Issued in WA

Legal business name

HALCYON RX INC

Doing business as

Medicine Man Liberty Lake

Practice address

23801 E Appleway Ave
Ste 260
Liberty Lake, WA 99019-9687

Phone

(509) 255-7611

Fax

(509) 755-3337

NPI assigned

Oct 10, 2006

Last updated

Nov 27, 2012By 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

John Amini, RPH

Title

President

Phone

(509) 255-7611

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• MEDICINE MAN LIBERTY LAKE 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.

• Jeffrey Foster, RPH

  • Pharmacist
  • Liberty Lake, WA
  • NPI 1619494028
  NPD (past)
• Kyle Frazier, PHARMD

  • Pharmacist
  • Spokane Valley, WA
  • NPI 1164944401
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1841387750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23801 E APPLEWAY AVE",
            "address_2": "STE 260",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199687",
            "telephone_number": "509-255-7611",
            "fax_number": "509-755-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23801 E APPLEWAY AVE",
            "address_2": "STE 260",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199687",
            "telephone_number": "509-255-7611",
            "fax_number": "509-755-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALCYON RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "AMINI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-255-7611",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.00059100",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4928593",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE MAN LIBERTY LAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Renee Gregorius, LMP
• Spencer Alan Grubb
• Brandon Tyler Gufford, PHARMD
• Magdalena J Haigh, ARNP
• Halcyon RX Inc (Medicine Man Liberty Lake)
• Morgan J Hammelev, LMT
• Ashley Anne Hamstra, M.D.
• Samantha K Hanson, LMT
• Julie Harnack
• Phillip Wayne Harris, LMP

• Community/Retail Pharmacy in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; 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.