Healthcare Provider Details

I. General information

NPI: 1043393861
Provider Name (Legal Business Name): RIVERS EDGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 STEVENSVILLE CUTOFF RD
STEVENSVILLE MT
59870-6496
US

IV. Provider business mailing address

39 STEVENSVILLE CUTOFF RD
STEVENSVILLE MT
59870-6496
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-4410
  • Fax: 406-777-4192
Mailing address:
  • Phone: 406-777-4410
  • Fax: 406-777-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14912
License Number StateMT

VIII. Authorized Official

Name: KLINTON CURTIS
Title or Position: OWNER, AO
Credential: RPH
Phone: 406-777-4410