Healthcare Provider Details

I. General information

NPI: 1003841016
Provider Name (Legal Business Name): TIMBER RIDGE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N 1ST ST
HAMILTON MT
59840-2150
US

IV. Provider business mailing address

1131 N 1ST ST
HAMILTON MT
59840-2150
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-9003
  • Fax: 406-363-9005
Mailing address:
  • Phone: 406-363-9003
  • Fax: 406-363-9005

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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1097
License Number StateMT

VIII. Authorized Official

Name: LANS RICHARDSON IV
Title or Position: OWNER/PHARMACY TECH
Credential:
Phone: 406-363-9003