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General NPI Number Information
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NPI Number | 1346338936
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Entity Type | Organization
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Legal Business Name | RED LODGE DRUG CO INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 211 N BROADWAY AVE
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City | RED LODGE
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State | MT
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Zip | 59068-9132
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Country | US
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Telephone | 406-446-1017
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Fax | 406-446-2516
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | RED LODGE
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State | MT
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Zip | 59068-1030
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Country | US
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Telephone | 406-446-1017
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Fax | 406-446-2516
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG C ERICKSON
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Credential | RPH
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Telephone | 406-446-1017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1249
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License Number State | MT
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