=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417055237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 63307 US HIGHWAY 93S
-----------------------------------------------------
City | RONAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-676-2111
-----------------------------------------------------
Fax | 406-676-2106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63307 US HIGHWAY 93S
-----------------------------------------------------
City | RONAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-676-2111
-----------------------------------------------------
Fax | 406-676-2106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | SHIREE E DUPUIS-RYAN
-----------------------------------------------------
Credential | CPRT OWNER
-----------------------------------------------------
Telephone | 406-253-2551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1120
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------