Healthcare Provider Details

I. General information

NPI: 1760576714
Provider Name (Legal Business Name): SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CASCADE LOOP SUITE 1
KALISPELL MT
59901
US

IV. Provider business mailing address

560 CASCADE LOOP SUITE 1
KALISPELL MT
59901
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-0440
  • Fax: 406-752-0443
Mailing address:
  • Phone: 406-752-0440
  • Fax: 406-752-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number10706
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1144
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1144
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number10706
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1144
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1144
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number1144
License Number StateMT

VIII. Authorized Official

Name: DAVID GRADY
Title or Position: PRESIDENT
Credential:
Phone: 406-752-0440