Provider Demographics
NPI:1013906429
Name:BITCH CREEK CORPORATION
Entity Type:Organization
Organization Name:BITCH CREEK CORPORATION
Other - Org Name:TOWNSEND DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-266-4379
Mailing Address - Street 1:308 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2222
Mailing Address - Country:US
Mailing Address - Phone:406-266-4379
Mailing Address - Fax:406-266-3727
Practice Address - Street 1:308 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2222
Practice Address - Country:US
Practice Address - Phone:406-266-4379
Practice Address - Fax:406-266-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT352753336C0003X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1013906429Medicaid
2158771OtherPK
MT2706375OtherNCPDP NUMBER