Provider Demographics
NPI:1013285840
Name:AUSTINS PHARMACY PLLC
Entity Type:Organization
Organization Name:AUSTINS PHARMACY PLLC
Other - Org Name:AUSTIN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-262-3098
Mailing Address - Street 1:5870 CHIEF YELLOWBULL TRL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-9591
Mailing Address - Country:US
Mailing Address - Phone:406-262-3098
Mailing Address - Fax:
Practice Address - Street 1:305 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3303
Practice Address - Country:US
Practice Address - Phone:406-555-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MT13403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2783795OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MT1013285840Medicaid