1972687937 NPI number — VALLEY DRUG OF MALTA, INC.

Table of content: (NPI 1972687937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972687937 NPI number — VALLEY DRUG OF MALTA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY DRUG OF MALTA, INC.
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:
Provider Other Organization Name Type Code:
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:
1972687937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 1240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALTA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-654-2632
Provider Business Mailing Address Fax Number:
406-654-1243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 S 1ST AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALTA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-654-2632
Provider Business Practice Location Address Fax Number:
406-654-1243
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZIEGLER
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-654-2632

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  28153 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 28153 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1972687937 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".