Provider Demographics
NPI:1730125626
Name:NEIL W DONNER
Entity Type:Organization
Organization Name:NEIL W DONNER
Other - Org Name:YELLOWSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-346-2134
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0289
Mailing Address - Country:US
Mailing Address - Phone:406-346-2134
Mailing Address - Fax:406-346-2136
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327
Practice Address - Country:US
Practice Address - Phone:406-356-2134
Practice Address - Fax:406-346-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MT6703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000219466Medicaid
2049904OtherPK
0305320001Medicare NSC