Organization
GRANITE PHARMACY MISSOULA, LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up