Healthcare Provider Details

I. General information

NPI: 1982709044
Provider Name (Legal Business Name): VDV, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST
STEVENSVILLE MT
59870-2531
US

IV. Provider business mailing address

301 MAIN ST
STEVENSVILLE MT
59870-2531
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5591
  • Fax: 406-777-5150
Mailing address:
  • Phone: 406-777-5591
  • Fax: 406-777-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1054
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number1054
License Number StateMT

VIII. Authorized Official

Name: MR. DAN L SEVERSON
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 406-777-5591