Provider Demographics
NPI:1871824300
Name:CASTLE MOUNTAIN DRUG PLLC
Entity Type:Organization
Organization Name:CASTLE MOUNTAIN DRUG PLLC
Other - Org Name:CASTLE MOUNTAIN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEREDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-547-2316
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59645-0415
Mailing Address - Country:US
Mailing Address - Phone:406-547-2316
Mailing Address - Fax:406-547-2162
Practice Address - Street 1:4271 US HIGHWAY 12 E
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59645
Practice Address - Country:US
Practice Address - Phone:406-547-2316
Practice Address - Fax:406-547-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
MTPHA-PHR-LIC-286483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123639OtherPK