Organization
LODGE GRASS HEALTH CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LARSEN (AREA BUSINESS OFFICE COORDINATOR)
(406) 247-7184
Entity
Organization
Contact information
Practice address
HARDING AVE, LODGE GRASS, MT 59050
(406) 639-2317
(406) 639-2976
Mailing address
HARDING AVE, PO BOX 780, LODGE GRASS, MT 59050
(406) 639-2317
(406) 639-2976
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2210085
—
MT
01
—
2762955
NCPDP NUMBER
—
Enumeration date
03/05/2007
Last updated
03/07/2023
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