MEDICINE MAN COMPOUNDING CENTER LLC (NPI# 1659907962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659907962 |
| Entity Type | Organization |
| Organization Name | MEDICINE MAN COMPOUNDING CENTER LLC |
| Practice Address |
565 N Vest St Post Falls ID 83854-7066 |
| Practice Telephone | 2087732499 |
| Practice Fax Number | 2087736309 |
| Mailing Telephone | 2087732499 |
| Mailing Fax Number | 2087736309 |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |
| Authorized Official Name | DONALD RAY SMITH (MANAGING PARNER) |
| Authorized Official Telephone | 2086615199 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Medicine Man Compounding Center LLC | Doing Business As Name - Organization |
| Street Address |
565 N VEST ST |
| City | POST FALLS |
| State | ID |
| Zip Code | 83854-7066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598868770 | Well Life Pharmacy Incorporated | Pharmacy | 565 N Vest St, Post Falls, ID 83854-7066 | 2006-09-06 |
| 1932552734 | Cindy Smith | Pharmacist | 565 N Vest St, Post Falls, ID 83854-7066 | 2016-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264032 | Esteem Counseling, LLC | Counselor | 1404 North Marcasite Court, Post Falls, ID 83854 | 2020-08-07 |
| 1497376685 | Teresa Marie Ragan | Registered Nurse | 1551 E Mullan Ave Bldg A, Ste 200b, Post Falls, ID 83854 | 2020-04-29 |
| 1245792910 | Samantha Patricia Bourassa | Specialist/Technologist | 2832 E Poleline Ave, Post Falls, ID 83854 | 2019-04-02 |
| 1003392598 | Joshua Welz | Psychologist | 3211 N Guinness Ln Apt 201, Post Falls, ID 83854 | 2018-07-17 |
| 1639608094 | Anthony Leodis Walls Jr. | Specialist/Technologist | 8732 N Meyer Rd, Post Falls, ID 83854 | 2017-06-08 |
| 1831635911 | Glenda Felts | Social Worker | 8561 N Cloverleaf Rd, # 22, Hauser, ID 83854 | 2017-01-12 |
| 1144763467 | Rachel M. Pope | Behavioral Analyst | 204 E 1st Ave Apt 4, Post Falls, ID 83854 | 2016-11-18 |
| 1871960393 | Randy Robinson | Massage Therapist | 2525 E Seltice Way Ste C, Post Falls, ID 83854 | 2015-09-01 |
| 1194112375 | James Bailey | Family Medicine | 185 W 4th Ave Ste B, Post Falls, ID 83854 | 2015-04-24 |
| 1033534953 | Lauren Tandy | Speech-Language Pathologist | 398 S. Corbin Rd., Post Falls, ID 83854 | 2014-02-28 |
| Find all providers in zip 83854 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner’s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598868770 | Well Life Pharmacy Incorporated | Pharmacy | 565 N Vest St, Post Falls, ID 83854-7066 | 2006-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1790321321 | Sawtooth Compounding Pharmacy, LLC | Pharmacy | 90 S Cole Rd, Boise, ID 83709-0930 | 2019-11-19 |
| 1518401512 | Ram Pharma, Inc. | Pharmacy | 1125 Hollipark Dr, Idaho Falls, ID 83401-5806 | 2016-12-09 |
| 1629456926 | K2red LLC | Pharmacy | 801 S Vista Ave, Boise, ID 83705-2424 | 2015-05-07 |
| 1578826178 | Medicine Man Bonners Ferry Pharmacy LLC | Pharmacy | 6452 Main St, Bonners Ferry, ID 83805-8520 | 2012-06-19 |
| 1891017208 | Hb Ventures Rx LLC | Pharmacy | 3355 E Louise Dr, Meridian, ID 83642-5047 | 2010-02-26 |
| 1457682114 | Custom Rx | Pharmacy | 173 W 4th St, Kuna, ID 83634-2046 | 2010-01-20 |
| 1972633915 | Maag Prescription Center LLC | Pharmacy | 333 W. Center St., Pocatello, ID 83204 | 2007-03-07 |
| 1780729988 | Customedica Pharmacy, Inc | Pharmacy | 149 W State St, Suite 101, Eagle, ID 83616-4959 | 2007-02-21 |
| 1083720494 | Shaver Holdings Inc | Pharmacy | 235 S 4th Ave, Pocatello, ID 83201-6438 | 2006-08-21 |
| Find all providers with the same taxonomy | ||||
| City | POST FALLS |
| Zip Code | 83854 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.