Healthcare Provider Details

I. General information

NPI: 1053083303
Provider Name (Legal Business Name): YELLOWSTONE PHARMACY OF FORSYTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN ST
FORSYTH MT
59327-9039
US

IV. Provider business mailing address

1025 MAIN ST
FORSYTH MT
59327-9039
US

V. Phone/Fax

Practice location:
  • Phone: 406-346-2134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEANNA SCHWEND
Title or Position: OWNER
Credential:
Phone: 406-351-2117