Healthcare Provider Details

I. General information

NPI: 1669795647
Provider Name (Legal Business Name): BROADUS FOODS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S PARK AVENUE
BROADUS MT
59317-0549
US

IV. Provider business mailing address

PO BOX 549
BROADUS MT
59317-0549
US

V. Phone/Fax

Practice location:
  • Phone: 406-436-2270
  • Fax: 406-436-2362
Mailing address:
  • Phone: 406-436-2270
  • Fax: 406-436-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1305
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMI JO SCHROEDER
Title or Position: PHARMACIST IN CHARGE/MANAGER
Credential:
Phone: 406-436-2270