=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073628012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINIC UNITED PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 12/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 11TH AVE S
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-5263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-727-0070
-----------------------------------------------------
Fax | 406-727-1028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 11TH AVE S
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-5263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-727-0070
-----------------------------------------------------
Fax | 406-727-1028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TIMOTHY LEVANDOWSKI
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 406-771-3399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1246
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------