Provider Demographics
NPI:1780135186
Name:ROSAUERS FOOD AND DRUG #27
Entity type:Organization
Organization Name:ROSAUERS FOOD AND DRUG #27
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:406-721-5330
Mailing Address - Street 1:2350 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6447
Mailing Address - Country:US
Mailing Address - Phone:406-721-5330
Mailing Address - Fax:406-721-4832
Practice Address - Street 1:2350 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6447
Practice Address - Country:US
Practice Address - Phone:406-721-5330
Practice Address - Fax:406-721-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-52213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy