Provider Demographics
NPI:1811403280
Name:406 RX, PLLC
Entity type:Organization
Organization Name:406 RX, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-388-8832
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-1469
Mailing Address - Country:US
Mailing Address - Phone:406-787-5313
Mailing Address - Fax:406-787-5813
Practice Address - Street 1:115 BROADWAY
Practice Address - Street 2:
Practice Address - City:CULBERTSON
Practice Address - State:MT
Practice Address - Zip Code:59218-0311
Practice Address - Country:US
Practice Address - Phone:406-787-5313
Practice Address - Fax:406-787-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MT503513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171796OtherPK
MT1811403280Medicaid