Organization
VANS IGA OF DILLON INC
Active
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
Update your record
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