Provider Demographics
NPI:1083751978
Name:FAIRFIELD DRUG INC
Entity Type:Organization
Organization Name:FAIRFIELD DRUG INC
Other - Org Name:FAIRFIELD DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-467-2336
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:MT
Mailing Address - Zip Code:59436-0247
Mailing Address - Country:US
Mailing Address - Phone:406-467-2336
Mailing Address - Fax:406-467-3363
Practice Address - Street 1:407 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:MT
Practice Address - Zip Code:59436
Practice Address - Country:US
Practice Address - Phone:406-467-2336
Practice Address - Fax:406-467-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1149332B00000X, 3336C0003X
333600000X
11493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2782919OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MT6214353Medicaid
5590240001Medicare NSC