Provider Demographics
NPI:1902942469
Name:GRANITE CNTY MED HOSP PHCY
Entity Type:Organization
Organization Name:GRANITE CNTY MED HOSP PHCY
Other - Org Name:GRANITE COUNTY MEDICAL HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMNSTR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:406-859-3271
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:MT
Mailing Address - Zip Code:59858-0729
Mailing Address - Country:US
Mailing Address - Phone:406-859-3271
Mailing Address - Fax:406-859-3011
Practice Address - Street 1:310 SANSOME ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:MT
Practice Address - Zip Code:59858-0729
Practice Address - Country:US
Practice Address - Phone:406-859-3271
Practice Address - Fax:406-859-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2523336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050006OtherPK
MT0310366Medicaid