Provider Demographics
NPI:1417055237
Name:FAMILY HEALTH PHARMACY
Entity Type:Organization
Organization Name:FAMILY HEALTH PHARMACY
Other - Org Name:FAMILY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIREE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUPUIS-RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPRT OWNER
Authorized Official - Phone:406-253-2551
Mailing Address - Street 1:63307 US HIGHWAY 93S
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864
Mailing Address - Country:US
Mailing Address - Phone:406-676-2111
Mailing Address - Fax:406-676-2106
Practice Address - Street 1:63307 US HIGHWAY 93S
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864
Practice Address - Country:US
Practice Address - Phone:406-676-2111
Practice Address - Fax:406-676-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2704597OtherNCPDP/NABP #
MT214825Medicaid
MT1009150001Medicare ID - Type UnspecifiedPHARMACY