NPI age
8 years
Enumerated 2018-03-11
● 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 1 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
8 years
↓ 11 yr below median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 70% of peers with subspecialties
NPI lifetime · 2018 → 2026
2018-03Enumerated in NPPES
2018
2026
Where they practice
Primary practice location
30585 N Roberts Rd
Hayden, ID 83835
Mailing address
Po Box 1706
Hayden, ID 838351706
Authorized official
Korey E Kreider, PHARMD
Coo
📞 2086603938
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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1851894380 | |
| 01 | 2176449 | PK |
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
MEDICINE MAN ATHOL PHARMACY
-
MEDICINE MAN ATHOL PHARMACY
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.