Organization
VANS IGA OF DILLON INC
Active
Other names
Vans Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE REBISH (PIC)
(406) 988-7121
Entity
Organization
Contact information
Practice address
110 SOUTHSIDE BLVD, DILLON, MT 59725-3536
(406) 988-7121
(406) 683-3540
Mailing address
110 SOUTHSIDE BLVD, DILLON, MT 59725-3536
(406) 988-7121
(406) 683-3540
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAPHRLIC14805
MT
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139191
PK
—
05
—
610084
—
MT
Enumeration date
02/28/2013
Last updated
02/20/2017
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