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Provider Information for 1154480861


The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.

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WHITEHALL PHARMACY INC

Other Names:  
Doing Business As: 
WHITEHALL DRUG

Organization Subpart: NO

NPI: 1154480861
Last Updated: 2020-12-09
Certification Date: 2020-12-09

Details

NameValue
NPI1154480861
Enumeration Date2006-12-08
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: CLIFFORD JOSH MORRIS Pharm D
Title: Owner
Phone: 4062873931
Mailing Address PO BOX 26
BOULDER, MT 59632-0026
United States

Phone: 406-287-3931 | Fax:406-287-9294
 
Primary Practice Address 411 E LEGION ST
WHITEHALL, MT 59759-7743
United States

Phone: 406-287-3931 | Fax:406-287-9294
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)MT0566878DME
MEDICAIDMT1154480861
MEDICAIDMT173035001B
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0004X - Pharmacy - Compounding Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy