Healthcare Provider Details

I. General information

NPI: 1871695213
Provider Name (Legal Business Name): MINERAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 RIVER ST
SUPERIOR MT
59872-9673
US

IV. Provider business mailing address

207 RIVER ST
SUPERIOR MT
59872-9673
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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number49935
License Number StateMT

VIII. Authorized Official

Name: DAVID BURNETT
Title or Position: OWNER/VP
Credential:
Phone: 406-822-4681