Healthcare Provider Details

I. General information

NPI: 1487100095
Provider Name (Legal Business Name): NORTH RIDGE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 SOUTH AVE W STE 102
MISSOULA MT
59804-6403
US

IV. Provider business mailing address

1107 HAZELTINE BLVD STE 200
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 406-258-7100
  • Fax: 406-251-1281
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number39645
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number39645
License Number StateMT

VIII. Authorized Official

Name: JAMES A WEICHERT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 952-361-8000