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General NPI Number Information
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NPI Number | 1316953102
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Entity Type | Organization
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Legal Business Name | LARRY'S IGA PHARMACY
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 S. PARK STREET
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City | BROADUS
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State | MT
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Zip | 59317
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Country | US
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Telephone | 406-436-2270
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Fax | 406-436-2338
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Provider Business Mailing Address
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Address Line | PO BOX 549 120 S. PARK STREET
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City | BROADUS
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State | MT
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Zip | 59317
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Country | US
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Telephone | 406-436-2270
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Fax | 406-436-2338
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. JOHN LAWRENCE LANE
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Credential | RPH.
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Telephone | 406-436-2270
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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 | 711
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License Number State | MT
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