Healthcare Provider Details

I. General information

NPI: 1699679837
Provider Name (Legal Business Name): TAMARACK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15837 N WESTWOOD DR
RATHDRUM ID
83858-6432
US

IV. Provider business mailing address

PO BOX B
ILWACO WA
98624-0167
US

V. Phone/Fax

Practice location:
  • Phone: 208-470-0035
  • Fax: 208-470-0036
Mailing address:
  • Phone: 208-470-0035
  • Fax: 208-470-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY HARRELL
Title or Position: PRESIDENT
Credential:
Phone: 360-859-8659