Provider Demographics
NPI:1013689660
Name:GARY AND LEOS INC
Entity Type:Organization
Organization Name:GARY AND LEOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MALISANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-265-1404
Mailing Address - Street 1:730 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3702
Mailing Address - Country:US
Mailing Address - Phone:406-265-1229
Mailing Address - Fax:406-265-3256
Practice Address - Street 1:730 1ST ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3702
Practice Address - Country:US
Practice Address - Phone:406-265-1229
Practice Address - Fax:406-265-3256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY AND LEO'S INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1679746549Medicaid