Healthcare Provider Details

I. General information

NPI: 1013689660
Provider Name (Legal Business Name): GARY AND LEOS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 1ST ST
HAVRE MT
59501-3702
US

IV. Provider business mailing address

730 1ST ST
HAVRE MT
59501-3702
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-1229
  • Fax: 406-265-3256
Mailing address:
  • Phone: 406-265-1229
  • Fax: 406-265-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURA LEE MALISANI
Title or Position: TREASURER
Credential:
Phone: 406-265-1404