Provider Demographics
NPI:1164559746
Name:PHARMFILL INC
Entity Type:Organization
Organization Name:PHARMFILL INC
Other - Org Name:RAILWAY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCAMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-844-2103
Mailing Address - Street 1:206 STONER LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MT
Mailing Address - Zip Code:59922-8503
Mailing Address - Country:US
Mailing Address - Phone:406-844-2103
Mailing Address - Fax:406-844-2106
Practice Address - Street 1:117 N MAIN ST # A
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-9013
Practice Address - Country:US
Practice Address - Phone:406-285-3883
Practice Address - Fax:406-285-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336L0003X
MTPHA-PHR-LIC-12753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052515OtherPK