Organization
GRANITE PHARMACY MISSOULA, LLC
Active
Other names
Granite Pharmacy Missoula
Organization subpart
No
Provider details
NPI number
Authorized official
TINA KOERNER (OWNER)
(406) 926-2941
Entity
Organization
Contact information
Practice address
2230 27TH AVE. WEST, SUITE 2, MISSOULA, MT 59804
(406) 926-2940
(406) 926-2944
Mailing address
2230 27TH AVE. WEST, SUITE 2, MISSOULA, MT 59804
(406) 926-2940
(406) 926-2944
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
18801
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447683651
—
MT
01
—
PHA-PHR-LIC-18801
MT PHARMACY LICENSE
MT
Enumeration date
08/12/2013
Last updated
01/08/2026
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