Organization
PAMIDA STORES OPERATING CO LLC
Active
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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