Provider Demographics
NPI:1659590172
Name:ROCKY MOUNTAIN PHARMACY
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:406-587-4332
Mailing Address - Street 1:25 N WILLSON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3585
Mailing Address - Country:US
Mailing Address - Phone:406-587-4332
Mailing Address - Fax:
Practice Address - Street 1:25 N WILLSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3585
Practice Address - Country:US
Practice Address - Phone:406-587-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10153336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0211769Medicaid