Healthcare Provider Details

I. General information

NPI: 1477069193
Provider Name (Legal Business Name): 406 RX PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST STE A
THREE FORKS MT
59752-9013
US

IV. Provider business mailing address

PO BOX 1469
COLUMBUS MT
59019-1469
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-3883
  • Fax: 406-285-3877
Mailing address:
  • Phone: 406-207-8043
  • Fax: 406-285-3877

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

VIII. Authorized Official

Name: JOSH FISHER
Title or Position: OWNER/PARTNER
Credential:
Phone: 406-207-8043