Provider Demographics
NPI:1124171426
Name:BOZEMAN HEALTH BIG SKY MEDICAL CENTER PHARMACY
Entity type:Organization
Organization Name:BOZEMAN HEALTH BIG SKY MEDICAL CENTER PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-414-5000
Mailing Address - Street 1:PO BOX 161529
Mailing Address - Street 2:334 TOWN CENTER AVE
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-1529
Mailing Address - Country:US
Mailing Address - Phone:406-995-6500
Mailing Address - Fax:406-995-6510
Practice Address - Street 1:334 TOWN CENTER AVE
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-1529
Practice Address - Country:US
Practice Address - Phone:406-995-6500
Practice Address - Fax:406-995-6510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOZEMAN HEALTH BIG SKY MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1124171426Medicaid
MT2782630OtherNCPDP #