Healthcare Provider Details

I. General information

NPI: 1285517268
Provider Name (Legal Business Name): SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N LAST CHANCE GULCH STE 1100 ROOM 1111
HELENA MT
59601-3551
US

IV. Provider business mailing address

630 N LAST CHANCE GULCH STE 1100 STE 1100 ROOM 1111
HELENA MT
59601-3551
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-0440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PEACOCK
Title or Position: GENERAL MANAGER
Credential: VA
Phone: 406-752-0440