Healthcare Provider Details

I. General information

NPI: 1629651690
Provider Name (Legal Business Name): MINERAL DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 RIVER ST
SUPERIOR MT
59872-9673
US

IV. Provider business mailing address

PO BOX 1407
PLAINS MT
59859-1407
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4681
  • Fax: 406-822-0057
Mailing address:
  • Phone: 406-822-4681
  • Fax: 406-822-0057

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREA R HOLMES
Title or Position: PRESIDENT/PHARMACIST
Credential: RPH
Phone: 406-822-4681