Healthcare Provider Details

I. General information

NPI: 1750260477
Provider Name (Legal Business Name): LITTLE SHELL TRIBE OF CHIPPEWA INDIANS OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SMELTER AVE NE
GREAT FALLS MT
59404-1927
US

IV. Provider business mailing address

511 CENTRAL AVE W
GREAT FALLS MT
59404-2848
US

V. Phone/Fax

Practice location:
  • Phone: 406-760-2055
  • Fax: 406-403-0436
Mailing address:
  • Phone: 406-760-2055
  • Fax: 406-403-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: GERALD GRAY JR.
Title or Position: CHAIRMAN
Credential:
Phone: 406-315-2400