| NPI | 1326142373 |
|---|---|
| Doing Business As | MEDICINE MAN LIBERTY LAKE |
| Entity Type | Organization |
| Authorized Contact | JOHN AMINI Owner And Pharmacist 509-755-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: WA FL0341254) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: WA FL0341254) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA FL0341254) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2008-02-12 |