Provider Demographics
NPI:1235283128
Name:SERVICE DRUG, INC.
Entity Type:Organization
Organization Name:SERVICE DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HAUGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-487-5911
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-1107
Mailing Address - Country:US
Mailing Address - Phone:406-487-5911
Mailing Address - Fax:406-487-5911
Practice Address - Street 1:119 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263
Practice Address - Country:US
Practice Address - Phone:406-487-5911
Practice Address - Fax:406-487-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1125OtherSTATE PHARMACY LICENSE
MT0212121Medicaid
2702137OtherNCPDP
2702137OtherNCPDP
2702137OtherNCPDP