MEDICARE: WHITEHALL PHARMACY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0566878	OTHER	MT	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154480861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITEHALL PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 26
Second Line	:
City	:	BOULDER
State	:	MT
Zip	:	59632-0026
Country	:	US
Telephone Number	:	406-287-3931
Fax Number	:	406-287-9294

Provider Business Practice Location Address
First Line	:	411 E LEGION ST
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-7743
Country	:	US
Telephone Number	:	406-287-3931
Fax Number	:	406-287-9294

Authorized Official
Title or Position	:	OWNER
Name	:	CLIFFORD JOSH MORRIS
Credential	:	PHARM D
Telephone Number	:	406-287-3931

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	12/09/2020

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Directions to “WHITEHALL PHARMACY INC ” Practice Location

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