=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205089588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST PETERS COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2008
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 E BROADWAY ST
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-444-2200
-----------------------------------------------------
Fax | 406-495-6809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 E BROADWAY ST
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-444-2200
-----------------------------------------------------
Fax | 406-447-2407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR DIRECTOR OF THERAPEUTICS
-----------------------------------------------------
Name | STARLA BLANK
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 406-444-2355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1272
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------