NPI age
19 years
Enumerated 2006-12-13
● Active Type 2 · Organization
Medicine Man North Pharmacy Inc
Medicine Man North Pharmacy Inc is 1 of 397 pharmacy organizations in Idaho.
Primary specialty
Pharmacy
Plus 2 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Kreider
Coo
Last NPPES update
2022-06-03
Source: monthly bulk 2026-05
How this organization compares
Across 397 active pharmacy providers in Idaho.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
2
In the 70% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-12Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
8093 N Cornerstone Dr
Hayden, ID 838358753
Mailing address
8093 N Cornerstone Dr
Hayden, ID 838358753
Authorized official
Korey E Kreider, PHARMD
Coo
📞 2086603938
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Shawna Daniels, RPH Pharmacist NPI 1215401922
- Jason Head Pharmacist NPI 1366868044
- Chax Peterson, PHARM. D. Pharmacist NPI 1407272065
- Jace Rogers, PHARMD Pharmacist NPI 1508584624
Specialties
-
Pharmacy PrimaryA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
-
PharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally...
-
PharmacyA pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 2021452 | PK |
| 05 (ID) | 1023179892 |
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
MEDICINE MAN PRAIRIE PHARMACY
-
MEDICINE MAN PRAIRIE PHARMACY
Practice context
Multi-provider organization. 4 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.