MEDICARE: UNIVERSITY OF MONTANA

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	307	MT
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	307	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366593345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MONTANA

Provider Business Mailing Address
First Line	:	634 EDDY AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59812-1851
Country	:	US
Telephone Number	:	406-243-5171
Fax Number	:	406-243-6185

Provider Business Practice Location Address
First Line	:	634 EDDY AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801
Country	:	US
Telephone Number	:	406-243-5171
Fax Number	:	406-243-6185

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	KENNETH CHATRIAND
Credential	:
Telephone Number	:	406-243-5171

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	03/09/2026

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Directions to “UNIVERSITY OF MONTANA ” Practice Location

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