Healthcare Provider Details

I. General information

NPI: 1770040693
Provider Name (Legal Business Name): NORTHWEST PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 01/06/2025
Certification Date: 01/02/2025
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:
Mailing address:
  • Phone:
  • Fax:

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ORA EDWARDS III
Title or Position: OWNER
Credential:
Phone: 208-875-1212