Organization
PLENTYWOOD DRUG INC.
Active
Other names
PLENTYWOOD REXALL DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN A EBERLING R.PH (OWNER)
(406) 765-1810
Entity
Organization
Contact information
Practice address
119 N MAIN ST, PLENTYWOOD, MT 59254-1817
(406) 765-1810
Mailing address
119 N MAIN ST, PLENTYWOOD, MT 59254-1817
(406) 765-1810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
984
MT
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
984
MT
3336C0003X
Community/Retail Pharmacy
Primary
984
MT
3336L0003X
Long Term Care Pharmacy
984
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073514428
MEDICARE
MT
05
—
219219
—
MT
Enumeration date
08/09/2005
Last updated
01/21/2016
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