Organization
PAMIDA STORES OPERATING CO LLC
Active
Other names
Pamida Pharmacy 696
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HARLOW (CEO/PRESIDENT)
(402) 596-7206
Entity
Organization
Contact information
Practice address
998 US HWY 93 NORTH, EUREKA, MT 59917-9550
(406) 297-3496
(406) 297-7496
Mailing address
998 US HWY 93 NORTH, EUREKA, MT 59917-9550
(406) 297-3496
(406) 297-7496
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1273
MT
3336C0003X
Community/Retail Pharmacy
Primary
1273
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1273
LICENSE NUMBER
MT
01
—
1932353158
MEDICAID DME
MT
01
—
2783466
NCPDP
MT
Enumeration date
11/14/2008
Last updated
11/23/2009
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