Provider Demographics
NPI:1194870279
Name:BUTTE IV PHARMACY, INC. D.B.A. HOME IV PHARMACY
Entity type:Organization
Organization Name:BUTTE IV PHARMACY, INC. D.B.A. HOME IV PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-723-4099
Mailing Address - Street 1:2601 1/2 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4542
Mailing Address - Country:US
Mailing Address - Phone:406-723-4099
Mailing Address - Fax:406-723-4059
Practice Address - Street 1:2601 1/2 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4542
Practice Address - Country:US
Practice Address - Phone:406-723-4099
Practice Address - Fax:406-723-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0211536Medicaid
MT560833Medicaid
MT5606583Medicaid
MT5606583Medicaid