MEDICARE: RIVERS EDGE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	14912	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2051944	OTHER		PK

General Provider Information

NPI Number	:	1043393861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERS EDGE PHARMACY INC

Provider Business Mailing Address
First Line	:	39 STEVENSVILLE CUTOFF RD
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-6496
Country	:	US
Telephone Number	:	406-777-4410
Fax Number	:	406-777-4192

Provider Business Practice Location Address
First Line	:	39 STEVENSVILLE CUTOFF RD
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-6496
Country	:	US
Telephone Number	:	406-777-4410
Fax Number	:	406-777-4192

Authorized Official
Title or Position	:	OWNER, AO
Name	:	KLINTON CURTIS
Credential	:	RPH
Telephone Number	:	406-777-4410

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/09/2015

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Directions to “RIVERS EDGE PHARMACY INC ” Practice Location

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