Provider Demographics
NPI:1417051764
Name:FRANKS EXPRESS DRUG PC
Entity Type:Organization
Organization Name:FRANKS EXPRESS DRUG PC
Other - Org Name:FRANKS 293 DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-293-3784
Mailing Address - Street 1:1401 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2309
Mailing Address - Country:US
Mailing Address - Phone:406-293-3784
Mailing Address - Fax:406-293-9546
Practice Address - Street 1:1401 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2309
Practice Address - Country:US
Practice Address - Phone:406-293-3784
Practice Address - Fax:406-293-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MT11293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0213248Medicaid
2763642OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MT5606345Medicaid
MT0213248Medicaid