Healthcare Provider Details

I. General information

NPI: 1013906429
Provider Name (Legal Business Name): BITCH CREEK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BROADWAY ST
TOWNSEND MT
59644-2222
US

IV. Provider business mailing address

308 BROADWAY ST
TOWNSEND MT
59644-2222
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-4379
  • Fax: 406-266-3727
Mailing address:
  • Phone: 406-266-4379
  • Fax: 406-266-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number35275
License Number StateMT

VIII. Authorized Official

Name: SETH WOLFGRAM
Title or Position: CEO
Credential:
Phone: 406-266-4379