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General NPI Number Information
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NPI Number | 1912940297
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Entity Type | Organization
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Legal Business Name | KOOTENAI DRUG AND HARDWARE INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 611 E MISSOULA AVE
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City | TROY
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State | MT
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Zip | 59935
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Country | US
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Telephone | 406-295-4361
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Fax | 406-295-5326
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Provider Business Mailing Address
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Address Line | 611 E MISSOULA AVE PO BOX 328
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City | TROY
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State | MT
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Zip | 59935
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Country | US
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Telephone | 406-295-4361
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Fax | 406-295-5326
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER HERMES
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Credential | RPH
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Telephone | 406-295-4361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 1150
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License Number State | MT
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