Provider Demographics
NPI:1700967288
Name:RIDGEWAY PHARMACY, LTD
Entity Type:Organization
Organization Name:RIDGEWAY PHARMACY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:406-642-6040
Mailing Address - Street 1:2824 HWY 93 N.
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875
Mailing Address - Country:US
Mailing Address - Phone:406-642-6040
Mailing Address - Fax:406-642-6050
Practice Address - Street 1:2824 HWY 93 N.
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875
Practice Address - Country:US
Practice Address - Phone:406-642-6040
Practice Address - Fax:406-642-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1119332B00000X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2706488OtherNABP NUMBER
MT1230190002Medicare NSC