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Organization
SHIELDS LLC
Active
Organization
SHIELDS LLC
Active
Other names
406 Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHIELDS (OWNER/ PIC)
(406) 541-4060
Entity
Organization
Contact information
Practice address
1315 WYOMING ST STE A, MISSOULA, MT 59801-1725
(406) 544-8808
(406) 541-0185
Mailing address
4108 LINCOLN RD, MISSOULA, MT 59802-3046
(406) 541-4060
(406) 541-9699
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336I0012X
Institutional Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
42790
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166083
PK
—
Enumeration date
11/03/2016
Last updated
03/11/2018
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