Healthcare Provider Details

I. General information

NPI: 1720011190
Provider Name (Legal Business Name): HEFFERNAN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SW HIGGINS AVE
MISSOULA MT
59803-3606
US

IV. Provider business mailing address

918 SW HIGGINS AVE
MISSOULA MT
59803-0000
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-4125
  • Fax: 406-549-8310
Mailing address:
  • Phone: 406-549-4125
  • Fax: 406-549-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: COREY ROBERT HEFFERNAN
Title or Position: PRESIDENT
Credential:
Phone: 406-273-2322