Provider Demographics
NPI:1720011190
Name:HEFFERNAN DRUG INC
Entity Type:Organization
Organization Name:HEFFERNAN DRUG INC
Other - Org Name:PALMER'S DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:406-273-2322
Mailing Address - Street 1:918 SW HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-0000
Mailing Address - Country:US
Mailing Address - Phone:406-549-4125
Mailing Address - Fax:406-549-8310
Practice Address - Street 1:918 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3606
Practice Address - Country:US
Practice Address - Phone:406-549-4125
Practice Address - Fax:406-549-8310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEFFERNAN DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
MT10393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0235175Medicaid
MT0686777Medicaid
MT00566228Medicaid
MT7092462Medicaid
MT00566228Medicaid