Healthcare Provider Details

I. General information

NPI: 1649222001
Provider Name (Legal Business Name): HAINES DRUG EUREKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 HWY. 93 N.
EUREKA MT
59917
US

IV. Provider business mailing address

998 HIGHWAY 93 NORTH
EUREKA MT
59917
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-3496
  • Fax: 406-297-7496
Mailing address:
  • Phone: 406-297-3496
  • Fax: 406-297-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number787
License Number StateMT

VIII. Authorized Official

Name: DR. JUSTIN S MACKENZIE
Title or Position: PHARMACIST/ASSISTANT MANAGER
Credential: PHARM. D
Phone: 406-297-3496