Provider Demographics
NPI:1740387661
Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Entity Type:Organization
Organization Name:BOZEMAN HEALTH DEACONESS HOSPITAL
Other - Org Name:HIGHLAND PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PHARMACIST SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMD
Authorized Official - Phone:406-585-5030
Mailing Address - Street 1:925 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6900
Mailing Address - Country:US
Mailing Address - Phone:406-414-1030
Mailing Address - Fax:406-414-5096
Practice Address - Street 1:925 HIGHLAND BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6900
Practice Address - Country:US
Practice Address - Phone:406-414-1030
Practice Address - Fax:406-414-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336I0012X, 3336S0011X
MT6643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000213434Medicaid
2050311OtherPK