Healthcare Provider Details

I. General information

NPI: 1659763217
Provider Name (Legal Business Name): MONTANA RX SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 MAIN ST STE. B101
COLSTRIP MT
59323-9520
US

IV. Provider business mailing address

PO BOX 2
COLUMBUS MT
59019-0002
US

V. Phone/Fax

Practice location:
  • Phone: 406-213-7010
  • Fax: 406-213-7009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA-PHR-LIC-28412
License Number StateMT

VIII. Authorized Official

Name: MR. MICHAEL ROBERT MATOVICH
Title or Position: MEMBER, MONTANA RX SOLUTIONS, PLLC
Credential: R.PH
Phone: 406-860-4044