MEDICARE: FAIRFIELD DRUG 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	332B00000X	Durable Medical Equipment & Medical Supplies	1149	MT
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy	1149
4	3336C0003X	Community/Retail Pharmacy	1149	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2782919	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083751978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFIELD DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436-0247
Country	:	US
Telephone Number	:	406-467-2336
Fax Number	:	406-467-3363

Provider Business Practice Location Address
First Line	:	407 CENTRAL AVE
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436
Country	:	US
Telephone Number	:	406-467-2336
Fax Number	:	406-467-3363

Authorized Official
Title or Position	:	OWNER/PHARMACIST IN CHARGE
Name	:	JILL TEX
Credential	:	PHARMD
Telephone Number	:	406-467-2336

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	11/09/2017

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Directions to “FAIRFIELD DRUG INC ” Practice Location

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