Provider Demographics
NPI:1649222001
Name:HAINES DRUG EUREKA, INC.
Entity Type:Organization
Organization Name:HAINES DRUG EUREKA, INC.
Other - Org Name:HAINES DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/ASSISTANT MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:406-297-3496
Mailing Address - Street 1:998 HIGHWAY 93 NORTH
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917
Mailing Address - Country:US
Mailing Address - Phone:406-297-3496
Mailing Address - Fax:406-297-7496
Practice Address - Street 1:998 HWY. 93 N.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-297-3496
Practice Address - Fax:406-297-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT214552Medicaid
MT787OtherMT PHARMACY #
MT2705323OtherNABP #
MTBH3952935OtherDEA #
MT2705323OtherNABP #