Provider Demographics
NPI:1255361168
Name:FLORENCE COMMUNITY PHARMACY, INC
Entity type:Organization
Organization Name:FLORENCE COMMUNITY PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-273-7979
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:5549 OLD HWY 93
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-1134
Mailing Address - Country:US
Mailing Address - Phone:406-273-7979
Mailing Address - Fax:406-273-7722
Practice Address - Street 1:5549 OLD US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6545
Practice Address - Country:US
Practice Address - Phone:406-273-7979
Practice Address - Fax:406-273-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0003X
MT11353336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT225787Medicaid
MT1135OtherMT STATE LICENSE #
MT2782680OtherNCPDP NUMBER
MT1135OtherMT STATE LICENSE #
MT2782680OtherNCPDP NUMBER