| NPI | 1851894380 |
|---|---|
| Doing Business As | MEDICINE MAN ATHOL 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 47570RP) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2018-03-11 |
| Last Update Date | 2022-06-03 |