Provider Demographics
NPI:1598281859
Name:BILLINGS CLINIC SPECIALTY SUPPLIES AND SERVICES, LLC
Entity Type:Organization
Organization Name:BILLINGS CLINIC SPECIALTY SUPPLIES AND SERVICES, LLC
Other - Org Name:BILLINGS CLINIC ALLCARE PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ULISHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-657-4740
Mailing Address - Street 1:1015 BROADWATER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5462
Mailing Address - Country:US
Mailing Address - Phone:406-435-5970
Mailing Address - Fax:406-435-5973
Practice Address - Street 1:1015 BROADWATER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-435-5970
Practice Address - Fax:406-435-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MTPHA-PHR-LIC-4713336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175574OtherPK