Provider Demographics
NPI:1598867939
Name:CULBERTSON PHARMACY INC
Entity type:Organization
Organization Name:CULBERTSON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISBEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-787-5313
Mailing Address - Street 1:BOX 311
Mailing Address - Street 2:
Mailing Address - City:CULBERTSON
Mailing Address - State:MT
Mailing Address - Zip Code:59218
Mailing Address - Country:US
Mailing Address - Phone:406-787-5313
Mailing Address - Fax:406-787-5813
Practice Address - Street 1:115 BROADWAY
Practice Address - Street 2:
Practice Address - City:CULBERTSON
Practice Address - State:MT
Practice Address - Zip Code:59218-0311
Practice Address - Country:US
Practice Address - Phone:406-787-5313
Practice Address - Fax:406-787-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MT10123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2051860OtherPK
0936370001Medicare NSC
2705450OtherOTHER ID NUMBER
0936370001Medicare NSC