Provider Demographics
NPI:1235236167
Name:KEPHAS CORPORATION
Entity Type:Organization
Organization Name:KEPHAS CORPORATION
Other - Org Name:SNYDER DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-452-6461
Mailing Address - Street 1:2515 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1909
Mailing Address - Country:US
Mailing Address - Phone:406-452-6461
Mailing Address - Fax:406-452-4833
Practice Address - Street 1:2515 6TH AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-1909
Practice Address - Country:US
Practice Address - Phone:406-452-6461
Practice Address - Fax:406-452-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MT12183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049916OtherPK
MT218076Medicaid