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MEDICINE MAN WEST PHARMACY LLC

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Company Details

Name: MEDICINE MAN WEST PHARMACY LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 20 Nov 1995 (30 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 11920
Place of Formation: IDAHO
File Number: 11920
ZIP code: 83854
County: Kootenai County
Principal Address: 802 E MEDICAL CT POST FALLS, ID 83854
Mailing Address: 802 E MEDICAL CT POST FALLS, ID 83854-7298

Agent

Name Role Address
DONALD R SMITH Agent 802 E MEDICAL CT, POST FALLS, ID 83854

Manager

Name Role Address Appointed On
Donald Smith Manager 9363 W DRIFTWOOD DRIVE, COEURDALENE, ID 83814 2020-11-24

Member

Name Role Address Appointed On Resigned On
KATHIE SMITH Member 9363 W DRIFTWOOD DRIVE, COEURDALENE, ID 83814 2023-12-09 2023-12-09

National Provider Identifier

NPI Number:
1124193487
Certification Date:
2024-01-19

Authorized Person:

Name:
DONALD SMITH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
No
Selected Taxonomy:
3336C0004X - Compounding Pharmacy
Is Primary:
No
Selected Taxonomy:
333600000X - Pharmacy
Is Primary:
No
Selected Taxonomy:
3336C0003X - Community/Retail Pharmacy
Is Primary:
Yes

Contacts:

Fax:
2087778239

Filing

Filing Name Filing Number Filing date
Annual Report 0006007177 2024-12-04
Annual Report 0005506719 2023-12-09
Annual Report 0004953205 2022-10-14
Annual Report 0004477634 2021-11-03
Annual Report 0004074421 2020-11-24

USAspending Awards / Financial Assistance

Date:
2021-11-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
AWARDTYPE: DIRECT LOANS ACTIVITIES TO BE PERFORMED: PROVIDE LOANS TO BUSINESSES IMPACTED BY THE COVID-19 PANDEMIC FOR UNINSURED OR OTHERWISE UNCOMPENSATED ECONOMIC INJURY. DELIVERABLES: LOANS EXPECTED OUTCOMES: EXPECTED OUTCOMES: ENABLE BUSINESSES TO FUND POST-DISASTER ORDINARY AND NECESSARY OPERATING EXPENSES UNTIL NORMAL OPERATIONS RESUME INTENDED BENEFICIARIES: SURVIVORS OF DISASTER SUBRECIPIENT ACTIVITIES: NA
Obligated Amount:
0.00
Face Value Of Loan:
500000.00
Total Face Value Of Loan:
500000.00
Date:
2020-04-07
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
313200.00
Total Face Value Of Loan:
313200.00

Paycheck Protection Program

Date Approved:
2020-04-07
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
313200
Current Approval Amount:
313200
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
317198.66

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Date of last update: 24 May 2025

Sources: Idaho Secretary of State