Provider Demographics
NPI:1629651690
Name:MINERAL DRUG, INC
Entity Type:Organization
Organization Name:MINERAL DRUG, INC
Other - Org Name:MINERAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-822-4681
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-1407
Mailing Address - Country:US
Mailing Address - Phone:406-822-4681
Mailing Address - Fax:406-822-0057
Practice Address - Street 1:207 RIVER ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-9673
Practice Address - Country:US
Practice Address - Phone:406-822-4681
Practice Address - Fax:406-822-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy