| NPI | 1023179892 |
|---|---|
| Doing Business As | MEDICINE MAN PRAIRIE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KOREY E KREIDER COO 208-660-3938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ID 1308RP) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2022-06-03 |