Healthcare Provider Details

I. General information

NPI: 1629724596
Provider Name (Legal Business Name): MT FAMILY RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

IV. Provider business mailing address

3804 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5002
  • Fax: 406-777-6924
Mailing address:
  • Phone: 406-777-5002
  • Fax: 406-777-6924

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. LEVI DONALD SHYPKOWSKI
Title or Position: PHARMACIST/ OWNER
Credential: PHARM.D.
Phone: 406-239-1277