Provider Demographics
NPI:1134290950
Name:GERALD GAMRATH
Entity Type:Organization
Organization Name:GERALD GAMRATH
Other - Org Name:LAWLER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTER PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAMRATH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-778-2418
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-1518
Mailing Address - Country:US
Mailing Address - Phone:406-778-2418
Mailing Address - Fax:406-778-3460
Practice Address - Street 1:21 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-1518
Practice Address - Country:US
Practice Address - Phone:406-778-2418
Practice Address - Fax:406-778-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MT445333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2703709OtherNATIONAL PHARMACY
MTX000215436Medicaid
MTX000215436Medicaid