Provider Demographics
NPI:1699875906
Name:NORTHTOWN DRUG LLC
Entity type:Organization
Organization Name:NORTHTOWN DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-434-5115
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-0917
Mailing Address - Country:US
Mailing Address - Phone:406-434-5115
Mailing Address - Fax:406-434-2373
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1906
Practice Address - Country:US
Practice Address - Phone:406-434-5115
Practice Address - Fax:406-434-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 332B00000X, 333600000X, 3336L0003X
MT12323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251S00000XAgenciesCommunity/Behavioral Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1699875906Medicaid
2049975OtherPK
2049975OtherPK