Provider Demographics
NPI:1356557938
Name:LINDBURG DRUG STRATA WEST CORP.
Entity type:Organization
Organization Name:LINDBURG DRUG STRATA WEST CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LINDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-676-8450
Mailing Address - Street 1:34012 TERRACE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-9871
Mailing Address - Country:US
Mailing Address - Phone:406-676-8450
Mailing Address - Fax:
Practice Address - Street 1:34012 TERRACE LAKE RD
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-9871
Practice Address - Country:US
Practice Address - Phone:406-676-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0488290001OtherPIN