| NPI | 1982821237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ANN JAQUETH Pharmacy Technician 406-293-3958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MT 884) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |