| NPI | 1205062098 |
|---|---|
| Doing Business As | GLACIER RIDGE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RENEE WILKONSKI-LARSON Owner/Manager/PIC 406-370-9877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MT 1288) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| 333600000X Pharmacy | |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2009-09-18 |