Provider Demographics
NPI:1912043522
Name:MITCHELLS DRUG INC
Entity Type:Organization
Organization Name:MITCHELLS DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITHCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-683-2316
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-0145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 E GLENDALE ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2505
Practice Address - Country:US
Practice Address - Phone:406-683-2316
Practice Address - Fax:406-683-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT2263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT238823Medicaid
2700892OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2700892OtherOTHER ID NUMBER
2700892OtherOTHER ID NUMBER-COMMERCIAL NUMBER