Provider Demographics
NPI:1528313376
Name:GARDEN PARK MANAGMENT, LLC
Entity type:Organization
Organization Name:GARDEN PARK MANAGMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-930-0286
Mailing Address - Street 1:136 MCLEOD
Mailing Address - Street 2:BOX 1490
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-1490
Mailing Address - Country:US
Mailing Address - Phone:406-932-5316
Mailing Address - Fax:406-932-5770
Practice Address - Street 1:136 MCLEOD
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011
Practice Address - Country:US
Practice Address - Phone:406-932-5316
Practice Address - Fax:406-932-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT122043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy