Active NPI
Medicine Man West LLC
- Community/Retail Pharmacy
- Post Falls, ID
National Provider Identifier
1982778403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1114RP
- Legal business name
- MEDICINE MAN WEST LLC
- Doing business as
- MEDICINE MAN SOUTHWEST PHARMACY
- Practice address
- 805 E Polston Ave
Post Falls, ID 83854-6044 - Phone
- (208) 777-7732
- Fax
- (208) 777-0201
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Donald Smith
- Title
- Owner
- Phone
- (208) 777-7732
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1114RP | ID | Primary |
Addresses
Primary practice location
805 E Polston Ave
Post Falls, ID 83854-6044
Mailing address
805 E Polston Ave
Post Falls, ID 83854-6044
Phone (208) 777-7732
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002599500 | Medicaid | ID | |
| 2021075 | Other | PK |
Other names 1
- MEDICINE MAN SOUTHWEST PHARMACY
National Provider Directory
National Provider Directory- Tax ID family
- Medicine Man Rathdrum Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Rathdrum, ID
- NPI 1982665923
Locations
805 E Polston Ave
Post Falls, ID 83854
Phone (208) 457-4112
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1473811200000",
"number": "1982778403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 E POLSTON AVE",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838546044",
"telephone_number": "208-777-7732",
"fax_number": "208-777-0201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 E POLSTON AVE",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838546044",
"telephone_number": "208-777-7732",
"fax_number": "208-777-0201"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICINE MAN WEST LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-17",
"last_updated": "2016-09-14",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "DONALD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-777-7732"
},
"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": "1114RP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002599500",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2021075",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MEDICINE MAN SOUTHWEST PHARMACY",
"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 Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.