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General NPI Number Information
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NPI Number | 1649222001
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Entity Type | Organization
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Legal Business Name | HAINES DRUG EUREKA, INC.
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 998 HWY. 93 N.
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City | EUREKA
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State | MT
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Zip | 59917
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Country | US
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Telephone | 406-297-3496
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Fax | 406-297-7496
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Provider Business Mailing Address
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Address Line | 998 HIGHWAY 93 NORTH
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City | EUREKA
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State | MT
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Zip | 59917
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Country | US
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Telephone | 406-297-3496
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Fax | 406-297-7496
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Authorized Official
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Title or Position | PHARMACIST/ASSISTANT MANAGER
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Name | DR. JUSTIN S MACKENZIE
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Credential | PHARM. D
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Telephone | 406-297-3496
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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 | 787
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License Number State | MT
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