| Organization Name: | INTERLAKE PHARMACY INC |
| NPI Number: | 1467425249 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIM BROWN (PHARMACIST/OWNER) |
| Mailing Address: | 700 W Ironwood Dr Suite 159 Coeur D Alene |
| State: | ID US |
| Postal Code: | 838142656 |
| Phone Number: | 2086646664 |
| Fax Number: | 2086648527 |
| NPI Enumeration Date: | 02/10/2006 |
| NPI Last Update Date: | 09/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 782CP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |