Provider Demographics
NPI:1215083654
Name:GARDEN CITY PHARMACY
Entity type:Organization
Organization Name:GARDEN CITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEBO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-549-0898
Mailing Address - Street 1:2910 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7676
Mailing Address - Country:US
Mailing Address - Phone:406-549-0898
Mailing Address - Fax:406-549-0873
Practice Address - Street 1:2910 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7676
Practice Address - Country:US
Practice Address - Phone:406-549-0898
Practice Address - Fax:406-549-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty