Provider Demographics
NPI:1114015344
Name:PUBLIC DRUG CO INC
Entity Type:Organization
Organization Name:PUBLIC DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:LEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-453-1497
Mailing Address - Street 1:324 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3114
Mailing Address - Country:US
Mailing Address - Phone:406-453-1497
Mailing Address - Fax:406-452-3106
Practice Address - Street 1:324 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3114
Practice Address - Country:US
Practice Address - Phone:406-453-1497
Practice Address - Fax:406-452-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT22-3574Medicaid
MT0466480001Medicare NSC