| NPI | 1962823054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER D BOHANNON Manager 406-219-1922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MT PHA-WDD-LIC-21852) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2020-05-26 |