1689912446 NPI number — CHESTER PHARMACY INC

Table of content: (NPI 1689912446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689912446 NPI number — CHESTER PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER PHARMACY 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:
CHESTER PHARMACY
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:
1689912446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 622
Provider Second Line Business Mailing Address:
30 MAIN STREET
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59522-0622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-759-5050
Provider Business Mailing Address Fax Number:
406-759-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-759-5050
Provider Business Practice Location Address Fax Number:
406-759-5051
Provider Enumeration Date:
01/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATKIN
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
406-759-5050

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2138626 . This is a "PK" identifier . This identifiers is of the category "OTHER".