=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295616001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ETHAN MEIDE PHARMD, RPH, MBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1645 VANDELAY AVE STE 302
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-389-2513
-----------------------------------------------------
Fax | 406-389-2539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 WAUKESHA AVE
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-403-3177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHA-PHA-LIC-79819
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------