Provider Demographics
NPI:1598052797
Name:FRANKS PHARMACY LLC
Entity Type:Organization
Organization Name:FRANKS PHARMACY LLC
Other - Org Name:GRANITE PHARMACY LIBBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-926-2940
Mailing Address - Street 1:2230 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5126
Mailing Address - Country:US
Mailing Address - Phone:406-293-3784
Mailing Address - Fax:406-926-2944
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:2011-07-08
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MT13323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1598052797Medicaid
2131160OtherPK