Organization
GLACIER RIDGE PHARMACY INC
Active
Other names
Glacier Ridge Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE WILKONSKI-LARSON RPH (OWNER/MANAGER/PIC)
(406) 370-9877
Entity
Organization
Contact information
Practice address
55 1ST AVENUE EAST N, KALISPELL, MT 59901-4001
(406) 755-7979
(406) 755-7981
Mailing address
55 1ST AVENUE EAST N, KALISPELL, MT 59901-4001
(406) 755-7979
(406) 755-7981
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1288
MT
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205062098
—
MT
01
—
2783531
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/07/2009
Last updated
09/18/2009
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