Provider Demographics
NPI:1922598481
Name:UNIVERSITY OF MONTANA
Entity Type:Organization
Organization Name:UNIVERSITY OF MONTANA
Other - Org Name:IPHARM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-243-5112
Mailing Address - Street 1:32 CAMPUS DR
Mailing Address - Street 2:SKAGGS BUILDING 216
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-1522
Mailing Address - Country:US
Mailing Address - Phone:406-243-4647
Mailing Address - Fax:406-243-4353
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:SKAGGS BUILDING 216
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-1522
Practice Address - Country:US
Practice Address - Phone:406-243-4647
Practice Address - Fax:406-243-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MTPHA-PHR-LIC-509823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177520OtherPK