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General NPI Number Information
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NPI Number | 1083946123
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Entity Type | Organization
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Legal Business Name | MIRX LLC
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Dates
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Enumeration Date | 01/30/2010
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 993 S 24TH ST W SUITE A
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City | BILLINGS
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State | MT
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Zip | 59102-7433
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Country | US
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Telephone | 406-869-6551
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Fax | 406-869-6552
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Provider Business Mailing Address
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Address Line | 993 S 24TH ST W SUITE A
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City | BILLINGS
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State | MT
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Zip | 59102-7433
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Country | US
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Telephone | 406-869-6551
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Fax | 406-869-6552
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. KEVIN LARSON
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Credential |
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Telephone | 406-245-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHA-PHR-LIC-27586
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PHA-PHR-LIC-27586
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License Number State | MT
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