Healthcare Provider Details

I. General information

NPI: 1700967288
Provider Name (Legal Business Name): RIDGEWAY PHARMACY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 HWY 93 N.
VICTOR MT
59875
US

IV. Provider business mailing address

2824 HWY 93 N.
VICTOR MT
59875
US

V. Phone/Fax

Practice location:
  • Phone: 406-642-6040
  • Fax: 406-642-6050
Mailing address:
  • Phone: 406-642-6040
  • Fax: 406-642-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1119
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number1119
License Number StateMT

VIII. Authorized Official

Name: MR. JAMES CLOUD
Title or Position: OWNER
Credential: C.PH.T
Phone: 406-642-6040