Provider Demographics
NPI:1699807321
Name:KCS WESTERN DRUG INC
Entity Type:Organization
Organization Name:KCS WESTERN DRUG INC
Other - Org Name:WESTERN DRUG OF LIVINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-222-7332
Mailing Address - Street 1:1313 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2900
Mailing Address - Country:US
Mailing Address - Phone:406-222-7332
Mailing Address - Fax:406-222-7370
Practice Address - Street 1:1313 W PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2900
Practice Address - Country:US
Practice Address - Phone:406-222-7332
Practice Address - Fax:406-222-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011003271OtherUS FLU
MTP00423568OtherRR FLU
MT1699807321Medicaid
2703331OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MT6148180001Medicare NSC