Organization
GLACIER RIDGE PHARMACY INC
Active
Other names
Alpine Ridge Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE WILKONSKI-LARSON RPH (OWNER/PIC)
(406) 370-9877
Entity
Organization
Contact information
Practice address
6475 US HIGHWAY 93 S, WHITEFISH, MT 59937-8282
(406) 862-7434
(406) 862-7432
Mailing address
6475 US HIGHWAY 93 S, WHITEFISH, MT 59937-8282
(406) 862-7434
(406) 862-7432
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1295
MT
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659504363
—
MT
01
—
2783567
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/27/2009
Last updated
12/13/2013
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