| NPI | 1750493698 |
|---|---|
| Doing Business As | MEDICINE MAN PHARMACY INC |
| Entity Type | Organization |
| Authorized Contact | BRIAN JORGENSEN President 208-666-2502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ID 657RP) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-07-01 |