MEDICARE: VALLEY DRUG OF MALTA, INC.

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	28153	MT
2	3336L0003X	Long Term Care Pharmacy	28153	MT
3	333600000X	Pharmacy

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

General Provider Information

NPI Number	:	1972687937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY DRUG OF MALTA, INC.

Provider Business Mailing Address
First Line	:	BOX 1240
Second Line	:
City	:	MALTA
State	:	MT
Zip	:	59538
Country	:	US
Telephone Number	:	406-654-2632
Fax Number	:	406-654-1243

Provider Business Practice Location Address
First Line	:	131 S 1ST AVE E
Second Line	:
City	:	MALTA
State	:	MT
Zip	:	59538
Country	:	US
Telephone Number	:	406-654-2632
Fax Number	:	406-654-1243

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GREGORY B ZIEGLER
Credential	:	RPH
Telephone Number	:	406-654-2632

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/09/2020

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