Provider Demographics
NPI:1326035585
Name:SANDPOINT DRUG INC
Entity Type:Organization
Organization Name:SANDPOINT DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH,PHARMD
Authorized Official - Phone:208-263-1408
Mailing Address - Street 1:604 N FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1520
Mailing Address - Country:US
Mailing Address - Phone:208-263-1408
Mailing Address - Fax:208-265-8784
Practice Address - Street 1:604 N FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1520
Practice Address - Country:US
Practice Address - Phone:208-263-1408
Practice Address - Fax:208-265-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ID3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0024047Medicaid
ID1911028OtherCMS GROUP PRICING NUMBER
ID002404900Medicaid