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Organization

MOUNTAIN COMPOUNDING

Active
Other names
Mountain Compounding
Organization subpart
No

Provider details

NPI number
Authorized official
GERARD HATHEWAY PHARM.D. (DIRECTOR OF PHARMACY)
(406) 541-3172
Entity
Organization

Contact information

Practice address
101 S CALIFORNIA ST, SUITE A, MISSOULA, MT 59801-1745
(406) 541-3172
(406) 541-3173
Mailing address
10 SOUTH CALIFORNIA ST, SUITE A, MISSOULA, MT 59801
(406) 541-3172
(406) 541-3173

Taxonomy

Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
1307
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2783682
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
06/21/2010
Last updated
11/28/2012
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