Provider Demographics
NPI:1316185218
Name:KCS WESTERN DRUG INC
Entity Type:Organization
Organization Name:KCS WESTERN DRUG INC
Other - Org Name:WESTERN DRUG LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-222-5120
Mailing Address - Street 1:1313 W PARK ST
Mailing Address - Street 2:STE B
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2900
Mailing Address - Country:US
Mailing Address - Phone:406-222-5120
Mailing Address - Fax:406-222-7947
Practice Address - Street 1:1313 W PARK ST
Practice Address - Street 2:STE B
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2900
Practice Address - Country:US
Practice Address - Phone:406-222-5120
Practice Address - Fax:406-222-7947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
MT12783336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2783480OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MT1316185218Medicaid