Healthcare Provider Details

I. General information

NPI: 1346338936
Provider Name (Legal Business Name): RED LODGE DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N BROADWAY AVE
RED LODGE MT
59068-9132
US

IV. Provider business mailing address

PO BOX 1030
RED LODGE MT
59068-1030
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-1017
  • Fax: 406-446-2516
Mailing address:
  • Phone: 406-446-1017
  • Fax: 406-446-2516

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1249
License Number StateMT

VIII. Authorized Official

Name: CRAIG C ERICKSON
Title or Position: PRESIDENT
Credential: RPH
Phone: 406-446-1017