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13D2100794 CLIA NUMBER - MEDICINE MAN BONNERS FERRY PHARMACY

Laboratory Demographics

CLIA Number: 13D2100794

Facility Name: MEDICINE MAN BONNERS FERRY PHARMACY

Facility Address:
6452 MAIN STREET
BONNERS FERRY, ID
ZIP 83805
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Facility Phone Number: 208 647-4021

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1578826178

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 13D2100794
LAB Type Pharmacy
Facility Name MEDICINE MAN BONNERS FERRY PHARMACY
Street 6452 MAIN STREET
City BONNERS FERRY
State ID
ZIP 83805
Phone 208 647-4021
CertificateType 4
CertificateEffectiveDate 8/21/2023
CertificateExpirationDate 8/20/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024