=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184398091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVMOR DRUG I, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2021
-----------------------------------------------------
Last Update Date | 08/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610 S 3RD ST W STE 100
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-9012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-721-6017
-----------------------------------------------------
Fax | 406-721-1006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610 S 3RD ST W STE 100
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-9012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-721-6017
-----------------------------------------------------
Fax | 406-721-1006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JILL ALLISON MUNOZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-721-6017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------