Healthcare Provider Details

I. General information

NPI: 1235283128
Provider Name (Legal Business Name): SERVICE DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAIN STREET
SCOBEY MT
59263
US

IV. Provider business mailing address

PO BOX 1107
SCOBEY MT
59263-1107
US

V. Phone/Fax

Practice location:
  • Phone: 406-487-5911
  • Fax: 406-487-5911
Mailing address:
  • Phone: 406-487-5911
  • Fax: 406-487-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1125
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1125
Identifier TypeOTHER
Identifier StateMT
Identifier IssuerSTATE PHARMACY LICENSE
# 2
Identifier0212121
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer
# 3
Identifier2702137
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP

VIII. Authorized Official

Name: ROBERT PAUL HAUGO
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 406-487-5911