1649222001 NPI number — HAINES DRUG EUREKA, INC.

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 1649222001 NPI number — HAINES DRUG EUREKA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAINES DRUG EUREKA, 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:
HAINES 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:
1649222001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
998 HIGHWAY 93 NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-297-3496
Provider Business Mailing Address Fax Number:
406-297-7496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
998 HWY. 93 N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-297-3496
Provider Business Practice Location Address Fax Number:
406-297-7496
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACKENZIE
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHARMACIST/ASSISTANT MANAGER
Authorized Official Telephone Number:
406-297-3496

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  787 , 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: 214552 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 787 . This is a "MT PHARMACY #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 2705323 . This is a "NABP #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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