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General NPI Number Information
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NPI Number | 1326564857
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Entity Type | Organization
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Legal Business Name | BILLINGS CLINIC SPECIALTY SUPPLIES AND SERVICES, LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1015 BROADWATER AVE STE 101
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City | BILLINGS
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State | MT
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Zip | 59102
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Country | US
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Telephone | 406-657-4545
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Fax | 406-435-6393
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Provider Business Mailing Address
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Address Line | 1015 BROADWATER AVE STE 101
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City | BILLINGS
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State | MT
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Zip | 59102-5446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, CHIEF FINANCIAL OFF
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Name | CONNIE PREWITT
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Credential |
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Telephone | 406-657-4546
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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-47172
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License Number State | MT
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