Provider Demographics
NPI:1982738415
Name:MONTANA PHARMACEUTICAL SERVICES
Entity Type:Organization
Organization Name:MONTANA PHARMACEUTICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHARTY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-755-8888
Mailing Address - Street 1:860 N MERIDIAN RD
Mailing Address - Street 2:SUITE A5
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3588
Mailing Address - Country:US
Mailing Address - Phone:406-755-8888
Mailing Address - Fax:
Practice Address - Street 1:860 N MERIDIAN RD
Practice Address - Street 2:SUITE A5
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3588
Practice Address - Country:US
Practice Address - Phone:406-755-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1092333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2705703OtherNABP
MT0213512Medicaid