Provider Demographics
NPI:1912028499
Name:BIGFORK DRUG, INC
Entity Type:Organization
Organization Name:BIGFORK DRUG, INC
Other - Org Name:BIGFORK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-837-4370
Mailing Address - Street 1:8111 MT HIGHWAY 35 STE 7
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-3589
Mailing Address - Country:US
Mailing Address - Phone:406-837-4370
Mailing Address - Fax:406-837-4390
Practice Address - Street 1:8111 MT HIGHWAY 35 STE 7
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3589
Practice Address - Country:US
Practice Address - Phone:406-837-4370
Practice Address - Fax:406-837-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
MT12243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0059176Medicaid
2052609OtherPK
5954280001Medicare NSC