MEDICARE: BENTON 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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	1151	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2049905	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467406389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTON PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-0549
Country	:	US
Telephone Number	:	406-622-5588
Fax Number	:	406-622-5088

Provider Business Practice Location Address
First Line	:	1418 FRONT ST
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-8884
Country	:	US
Telephone Number	:	406-622-5588
Fax Number	:	406-622-5088

Authorized Official
Title or Position	:	RPH,OWNER
Name	:	CHRIS HALKO
Credential	:	BS
Telephone Number	:	406-622-5588

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/16/2023

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Directions to “BENTON PHARMACY INC ” Practice Location

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