Provider Demographics
NPI:1487643318
Name:ST JOHNS LUTHERAN MINISTRIES, INC
Entity Type:Organization
Organization Name:ST JOHNS LUTHERAN MINISTRIES, INC
Other - Org Name:ST. JOHN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MHSA
Authorized Official - Phone:406-655-5836
Mailing Address - Street 1:3940 RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0141
Mailing Address - Country:US
Mailing Address - Phone:406-655-5827
Mailing Address - Fax:406-655-5610
Practice Address - Street 1:3940 RIMROCK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0141
Practice Address - Country:US
Practice Address - Phone:406-655-5827
Practice Address - Fax:406-655-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT10183336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052029OtherPK
MT0005602996Medicaid
1588653679Medicare UPIN
MT0005602996Medicaid
275024Medicare Oscar/Certification