Provider Demographics
NPI:1548228976
Name:APPLIED HEALTH SERVICES INCORPORATED
Entity Type:Organization
Organization Name:APPLIED HEALTH SERVICES INCORPORATED
Other - Org Name:LOGAN HEALTH PHARMACY - CLINICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANG
Authorized Official - Prefix:
Authorized Official - First Name:TERA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-751-7600
Mailing Address - Street 1:200 CONWAY DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:406-751-7600
Mailing Address - Fax:406-257-5230
Practice Address - Street 1:200 CONWAY DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3112
Practice Address - Country:US
Practice Address - Phone:406-751-7600
Practice Address - Fax:406-257-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336H0001X, 3336L0003X, 3336M0003X, 3336S0011X
MT12573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1548228976Medicaid
2052669OtherPK
2052669OtherPK
011003674Medicare PIN