Provider Demographics
NPI:1265676100
Name:ELKHORN PHARMACY INC
Entity Type:Organization
Organization Name:ELKHORN PHARMACY INC
Other - Org Name:ELKHORN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-225-3240
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:406-225-3240
Mailing Address - Fax:406-225-3246
Practice Address - Street 1:215 N MAIN
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-0026
Practice Address - Country:US
Practice Address - Phone:406-225-3240
Practice Address - Fax:406-225-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MT12823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1265676100Medicaid
2119902OtherPK