Healthcare Provider Details

I. General information

NPI: 1003338765
Provider Name (Legal Business Name): HUSTON HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 01/19/2022
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

IV. Provider business mailing address

154 MANNINGTON ST
KALISPELL MT
59901-8842
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-7070
  • Fax: 406-862-7088
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW JAMES HUSTON
Title or Position: OWNER
Credential: PHARMD
Phone: 406-459-5254