Provider Demographics
NPI:1740219765
Name:STOKES PHARMACY ANACONDA INC
Entity Type:Organization
Organization Name:STOKES PHARMACY ANACONDA INC
Other - Org Name:STOKES PHARMACY ANACONDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-808-4489
Mailing Address - Street 1:1525 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1829
Mailing Address - Country:US
Mailing Address - Phone:406-563-8410
Mailing Address - Fax:406-563-8438
Practice Address - Street 1:1525 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1829
Practice Address - Country:US
Practice Address - Phone:406-563-8410
Practice Address - Fax:406-563-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MTPHAPHRLIC283583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1740219765Medicaid
2150584OtherPK
MT0237520144Medicare NSC
MT0000220779Medicaid
MT1740219765Medicare PIN
2705246OtherOTHER ID NUMBER-COMMERCIAL NUMBER