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General NPI Number Information
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NPI Number | 1548581960
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Entity Type | Organization
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Legal Business Name | MOUNTAIN COMPOUNDING
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 101 S CALIFORNIA ST SUITE A
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City | MISSOULA
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State | MT
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Zip | 59801-1745
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Country | US
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Telephone | 406-541-3172
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Fax | 406-541-3173
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Provider Business Mailing Address
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Address Line | 10 SOUTH CALIFORNIA ST SUITE A
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City | MISSOULA
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State | MT
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Zip | 59801
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Country | US
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Telephone | 406-541-3172
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Fax | 406-541-3173
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | GERARD HATHEWAY
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Credential | PHARM.D.
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Telephone | 406-541-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 1307
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License Number State | MT
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