Provider Demographics
NPI:1255500740
Name:CHOTEAU DRUG, INC
Entity Type:Organization
Organization Name:CHOTEAU DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLFE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-466-2700
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:102 N MAIN AVE
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-0040
Mailing Address - Country:US
Mailing Address - Phone:406-466-2700
Mailing Address - Fax:406-466-5204
Practice Address - Street 1:102 MAIN AVE NORTH
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-0040
Practice Address - Country:US
Practice Address - Phone:406-466-2700
Practice Address - Fax:406-466-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT830332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1376608216OtherNPI
MT0232193Medicaid
MT0568646Medicaid
MT0232193Medicaid