Provider Demographics
NPI:1750089686
Name:WOLVES DEN PHARMACY INC
Entity type:Organization
Organization Name:WOLVES DEN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-378-5588
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0321
Mailing Address - Country:US
Mailing Address - Phone:406-378-5588
Mailing Address - Fax:406-378-5088
Practice Address - Street 1:99 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:MT
Practice Address - Zip Code:59479-9582
Practice Address - Country:US
Practice Address - Phone:406-378-5588
Practice Address - Fax:406-378-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy