Provider Demographics
NPI:1043057961
Name:NORTHTOWN DRUG LLC
Entity type:Organization
Organization Name:NORTHTOWN DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-434-5115
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-0917
Mailing Address - Country:US
Mailing Address - Phone:406-434-5115
Mailing Address - Fax:406-434-2373
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1906
Practice Address - Country:US
Practice Address - Phone:406-434-5115
Practice Address - Fax:406-434-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy