1699807321 NPI number — KCS WESTERN DRUG INC

Table of content: (NPI 1699807321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699807321 NPI number — KCS WESTERN DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KCS WESTERN DRUG 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:
WESTERN DRUG OF LIVINGSTON
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:
1699807321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 W PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59047-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-222-7332
Provider Business Mailing Address Fax Number:
406-222-7370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 W PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59047-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-222-7332
Provider Business Practice Location Address Fax Number:
406-222-7370
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VONDRA
Authorized Official First Name:
KARI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-222-7332

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  1145 , 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: 011003271 . This is a "US FLU" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: P00423568 . This is a "RR FLU" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1699807321 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2703331 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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