MEDICARE: HEFFERNAN 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	8859	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
2	2134770	OTHER		PK

General Provider Information

NPI Number	:	1639435399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEFFERNAN DRUG INC

Provider Business Mailing Address
First Line	:	103 GLACIER DR
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847-8700
Country	:	US
Telephone Number	:	406-273-2322
Fax Number	:	406-273-4208

Provider Business Practice Location Address
First Line	:	103 GLACIER DR
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847-8700
Country	:	US
Telephone Number	:	406-273-2322
Fax Number	:	406-273-4208

Authorized Official
Title or Position	:	OWNER
Name	:	COREY ROBERT HEFFERNANA
Credential	:	PHARMD
Telephone Number	:	406-273-2322

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	05/17/2020

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Directions to “HEFFERNAN DRUG INC ” Practice Location

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