Provider Demographics
NPI:1124251095
Name:EUREKA DRUG INC
Entity type:Organization
Organization Name:EUREKA DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-297-7748
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-0305
Mailing Address - Country:US
Mailing Address - Phone:406-297-7748
Mailing Address - Fax:406-297-7492
Practice Address - Street 1:546 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9053
Practice Address - Country:US
Practice Address - Phone:406-297-7748
Practice Address - Fax:833-642-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X, 3336C0004X
MT153033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1124251095Medicaid
2121746OtherPK
6367950001Medicare NSC