MEDICARE: NEIL W DONNER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	670	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2049904	OTHER		PK

General Provider Information

NPI Number	:	1730125626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIL W DONNER

Provider Business Mailing Address
First Line	:	PO BOX 289
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327-0289
Country	:	US
Telephone Number	:	406-346-2134
Fax Number	:	406-346-2136

Provider Business Practice Location Address
First Line	:	1025 MAIN ST
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327
Country	:	US
Telephone Number	:	406-356-2134
Fax Number	:	406-346-2136

Authorized Official
Title or Position	:	OWNER
Name	:	NEIL DONNER
Credential	:	RPH
Telephone Number	:	406-346-2134

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/09/2017

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