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General NPI Number Information
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NPI Number | 1639129497
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Entity Type | Organization
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Legal Business Name | HAINES MEDICAL PHARMACY, INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1111 BAKER AVE
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City | WHITEFISH
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State | MT
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Zip | 59937-2905
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Country | US
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Telephone | 406-862-6301
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Fax | 406-862-6312
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Provider Business Mailing Address
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Address Line | 1111 BAKER AVE
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City | WHITEFISH
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State | MT
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Zip | 59937-2905
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Country | US
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Telephone | 406-862-6301
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Fax | 406-862-6312
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Authorized Official
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Title or Position | OWNER/PHARMACY MANAGER
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Name | DR. JUSTIN S MACKENZIE
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Credential | PHARM. D
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Telephone | 406-862-6301
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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 | 1064
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License Number State | MT
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