Provider Demographics
NPI:1699236018
Name:DAHL MEMORIAL HEALTHCARE ASSOCIATION INC
Entity type:Organization
Organization Name:DAHL MEMORIAL HEALTHCARE ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-425-0432
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:EKALAKA
Mailing Address - State:MT
Mailing Address - Zip Code:59324-0046
Mailing Address - Country:US
Mailing Address - Phone:406-775-8896
Mailing Address - Fax:833-678-0285
Practice Address - Street 1:106 E PARK ST
Practice Address - Street 2:
Practice Address - City:EKALAKA
Practice Address - State:MT
Practice Address - Zip Code:59324-0046
Practice Address - Country:US
Practice Address - Phone:406-775-8896
Practice Address - Fax:833-678-0285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAHL MEMORIAL HEALTHCARE ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-28
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1699236018Medicaid