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General NPI Number Information
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NPI Number | 1548112352
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Entity Type | Organization
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Legal Business Name | GEM STATE WELLNESS PHARMACY
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 247 RIVER VISTA PL STE 101
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City | TWIN FALLS
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State | ID
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Zip | 83301-3019
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Country | US
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Telephone | 208-329-8563
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Fax | 208-510-6627
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Provider Business Mailing Address
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Address Line | 1516 W BLUE DOWNS ST
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City | MERIDIAN
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State | ID
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Zip | 83642-8496
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Country | US
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Telephone | 208-329-8563
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Fax | 208-510-6627
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Authorized Official
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Title or Position | MANAGER/PHARMACIST
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Name | LOGAN WEAVER
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Credential | PHARMD
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Telephone | 208-329-8563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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