Organization
MINERAL PHARMACY INC
Active
Other names
MINERAL PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BURNETT (OWNER/VP)
(406) 822-4681
Entity
Organization
Contact information
Practice address
207 RIVER ST, SUPERIOR, MT 59872-9673
(406) 822-4681
(406) 822-0057
Mailing address
207 RIVER ST, SUPERIOR, MT 59872-9673
(406) 822-4681
(406) 822-0057
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
49935
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871695213
—
MT
01
—
2050377
PK
—
Enumeration date
09/05/2006
Last updated
07/19/2018
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