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General NPI Number Information
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NPI Number | 1720948524
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Entity Type | Organization
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Legal Business Name | TAMARACK PHARMACY LLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 15837 N WESTWOOD DR
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City | RATHDRUM
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State | ID
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Zip | 83858-6432
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Country | US
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Telephone | 208-457-4112
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Fax | 208-457-4122
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | ILWACO
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State | WA
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Zip | 98624-0167
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Country | US
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Telephone | 208-457-4112
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Fax | 208-457-4122
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY SHANE HARRELL
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Credential | PHARMD
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Telephone | 360-859-8659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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