Provider Demographics
NPI:1881810497
Name:COLE DRUG
Entity type:Organization
Organization Name:COLE DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-932-5316
Mailing Address - Street 1:136 MCLEOD
Mailing Address - Street 2:BOX1490
Mailing Address - City:BIGTIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011
Mailing Address - Country:US
Mailing Address - Phone:406-932-5316
Mailing Address - Fax:406-932-5770
Practice Address - Street 1:136 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:BIGTIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011
Practice Address - Country:US
Practice Address - Phone:406-932-5316
Practice Address - Fax:406-932-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1105332BX2000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5515710001Medicare ID - Type Unspecified
MT5515710001Medicare ID - Type UnspecifiedDME,PHARMACY