Provider Demographics
NPI:1093870560
Name:CORVALLIS DRUG INC
Entity Type:Organization
Organization Name:CORVALLIS DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KLINTON
Authorized Official - Middle Name:KYP
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:406-642-9891
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:1029 MAIN STREET
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-0009
Mailing Address - Country:US
Mailing Address - Phone:406-961-3221
Mailing Address - Fax:406-961-4344
Practice Address - Street 1:1029 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-0009
Practice Address - Country:US
Practice Address - Phone:406-961-3221
Practice Address - Fax:406-961-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MT1034333600000X
MT13-30123347C00000X, 347C00000X
MT3548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2700791OtherNABP
MT562822Medicaid
MT562822Medicaid