Healthcare Provider Details

I. General information

NPI: 1164559746
Provider Name (Legal Business Name): PHARMFILL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

206 STONER LOOP
LAKESIDE MT
59922-8503
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-3883
  • Fax: 406-285-3877
Mailing address:
  • Phone: 406-844-2103
  • Fax: 406-844-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA-PHR-LIC-1275
License Number StateMT

VIII. Authorized Official

Name: KERI VANCAMPEN
Title or Position: OWNER
Credential:
Phone: 406-844-2103