Organization
LANDMARK SPECIALTY COMPOUNDING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLA NICOLE TRIPP PHARMD (PHARMACIST)
(406) 545-4656
Entity
Organization
Contact information
Practice address
2825 STOCKYARD RD STE A26, MISSOULA, MT 59808-1547
(406) 493-6161
Mailing address
2825 STOCKYARD RD STE A26, MISSOULA, MT 59808-1547
(406) 545-4656
(406) 204-5512
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHA-PHR-LIC-74999
LICENSE
MT
Enumeration date
06/19/2021
Last updated
06/24/2021
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