1134290950 NPI number — GERALD GAMRATH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134290950 NPI number — GERALD GAMRATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD GAMRATH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAWLER DRUG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134290950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59313-1518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-778-2418
Provider Business Mailing Address Fax Number:
406-778-3460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59313-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-778-2418
Provider Business Practice Location Address Fax Number:
406-778-3460
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAMRATH
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
REGISTER PHARMACIST OWNER
Authorized Official Telephone Number:
406-778-2418

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 445 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2703709 . This is a "NATIONAL PHARMACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: X000215436 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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