# SWEETWATER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114245867
- **Authorized official:** MR. GABRIEL MCMURRAY (OWNER)
- **Authorized official phone:** (406) 541-0420

## Contact information

- **Practice address:** 5707 W HARRIER DR, MISSOULA, MT 59808-5345
- **Practice address phone:** (406) 541-0420
- **Mailing address:** 5707 W HARRIER DR, MISSOULA, MT 59808-5345
- **Mailing address phone:** (406) 541-0420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | BL20100152 | MT | Yes |

## Other

- **Enumeration date:** 05/05/2010
- **Last updated:** 05/05/2010