Provider Demographics
NPI:1679746549
Name:GARY AND LEOS INC
Entity Type:Organization
Organization Name:GARY AND LEOS INC
Other - Org Name:HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MALISANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-399-0706
Mailing Address - Street 1:730 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501
Mailing Address - Country:US
Mailing Address - Phone:406-265-1229
Mailing Address - Fax:406-265-3256
Practice Address - Street 1:730 1ST ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3702
Practice Address - Country:US
Practice Address - Phone:406-265-1229
Practice Address - Fax:406-265-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 332B00000X, 333600000X
MT12563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251S00000XAgenciesCommunity/Behavioral Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1679746549Medicaid
2052668OtherPK
6111080001Medicare NSC