MEDICARE: MINERAL DRUG, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1629651690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINERAL DRUG, INC

Provider Business Mailing Address
First Line	:	PO BOX 1407
Second Line	:
City	:	PLAINS
State	:	MT
Zip	:	59859-1407
Country	:	US
Telephone Number	:	406-822-4681
Fax Number	:	406-822-0057

Provider Business Practice Location Address
First Line	:	207 RIVER ST
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9673
Country	:	US
Telephone Number	:	406-822-4681
Fax Number	:	406-822-0057

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST
Name	:	ANDREA R HOLMES
Credential	:	RPH
Telephone Number	:	406-822-4681

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	09/16/2021

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Directions to “MINERAL DRUG, INC ” Practice Location

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