Healthcare Provider Details

I. General information

NPI: 1144356494
Provider Name (Legal Business Name): NORTHWEST PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/26/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 6TH ST
POTLATCH ID
83855-9700
US

IV. Provider business mailing address

PO BOX 657
POTLATCH ID
83855-0657
US

V. Phone/Fax

Practice location:
  • Phone: 208-875-1212
  • Fax: 208-875-0859
Mailing address:
  • Phone: 208-875-1212
  • Fax: 208-875-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number814CP
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WIL O EDWARDS
Title or Position: PHARMACIST
Credential: PHARMACIST
Phone: 208-875-1212