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General NPI Number Information
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NPI Number | 1326183724
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Entity Type | Organization
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Legal Business Name | MEDICINE MAN, INC.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 323 N 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-3605
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Country | US
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Telephone | 877-789-0800
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Fax | 206-781-8006
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Provider Business Mailing Address
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Address Line | 323 N 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-3605
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Country | US
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Telephone | 877-789-0800
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Fax | 206-781-8006
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOUGLAS ALAN HENDRICKS
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Credential |
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Telephone | 877-789-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00004196
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License Number State | WA
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