Healthcare Provider Details

I. General information

NPI: 1609881242
Provider Name (Legal Business Name): BERGUM DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WINNE AVE
HELENA MT
59601-4900
US

IV. Provider business mailing address

PO BOX 6487
HELENA MT
59604-6487
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-0506
  • Fax: 406-449-6273
Mailing address:
  • Phone: 406-443-0505
  • Fax: 406-449-6273

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number20375
License Number StateMT

VIII. Authorized Official

Name: RON BERGUM
Title or Position: OWNER PRESIDENT
Credential: RPH
Phone: 406-443-0505