Provider Demographics
NPI:1154480861
Name:WHITEHALL PHARMACY INC
Entity Type:Organization
Organization Name:WHITEHALL PHARMACY INC
Other - Org Name:WHITEHALL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:JOSH
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:406-287-3931
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0026
Mailing Address - Country:US
Mailing Address - Phone:406-287-3931
Mailing Address - Fax:406-287-9294
Practice Address - Street 1:411 E LEGION ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-7743
Practice Address - Country:US
Practice Address - Phone:406-287-3931
Practice Address - Fax:406-287-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0566878OtherDME
MT173035001BMedicaid
MT1154480861Medicaid