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NPI Code Detail

MEDICARE: WELL LIFE PHARMACY INCORPORATED

MEDICARE: WELL LIFE PHARMACY INCORPORATED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPHAR.CF.60586627WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42110399OTHERPK

General Provider Information

NPI Number : 1386747558
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELL LIFE PHARMACY INCORPORATED
Provider Business Mailing Address
First Line : PO BOX 1687
Second Line :
City : BONNERS FERRY
State : ID
Zip : 83805-1687
Country : US
Telephone Number : 208-267-8929
Fax Number : 208-267-8085
Provider Business Practice Location Address
First Line : 5608 S REGAL ST STE 102
Second Line :
City : SPOKANE
State : WA
Zip : 99223-7957
Country : US
Telephone Number : 509-838-0896
Fax Number : 509-838-1085
Authorized Official
Title or Position : OWNER
Name : JEFF FOSTER
Credential : RPH
Telephone Number : 208-267-4004
Provider Enumeration Date : 09/06/2006
Last Update Date : 01/18/2017

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Directions to “WELL LIFE PHARMACY INCORPORATED ” Practice Location

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