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General NPI Number Information
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NPI Number | 1073853941
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Entity Type | Organization
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Legal Business Name | VANS IGA OF DILLON INC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 110 SOUTHSIDE BLVD
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City | DILLON
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State | MT
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Zip | 59725-3536
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Country | US
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Telephone | 406-988-7121
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Fax | 406-683-3540
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Provider Business Mailing Address
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Address Line | 110 SOUTHSIDE BLVD
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City | DILLON
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State | MT
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Zip | 59725-3536
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Country | US
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Telephone | 406-988-7121
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Fax | 406-683-3540
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Authorized Official
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Title or Position | PIC
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Name | BONNIE REBISH
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Credential |
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Telephone | 406-988-7121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHAPHRLIC14805
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License Number State | MT
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