MISSOULA FRESH MARKET LLC (NPI# 1720024359) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720024359 |
| Entity Type | Organization |
| Organization Name | MISSOULA FRESH MARKET LLC |
| Other Organization Name | MISSOULA FRESH MARKET PHARMACY #1-3417 |
| Practice Address |
800 W Broadway St Missoula MT 59802-3944 |
| Mailing Address |
2520 39th St Missoula MT 59803-1029 |
| Practice Telephone | 4067216009 |
| Practice Fax Number | 4067216021 |
| Mailing Telephone | 4062517170 |
| Mailing Fax Number | 4062510340 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2015-11-09 |
| Authorized Official Name | ROBERT HASQUET (OWNER - PIC) |
| Authorized Official Telephone | 4068305572 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | 28282 | MT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2150151 | 01 |
| Other Name | Type Code |
|---|---|
| Missoula Fresh Market Pharmacy #1-3417 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194754119 | Missoula Fresh Market LLC | Pharmacy | 3801 S Reserve St, Missoula, MT 59801-7322 | 2006-07-02 |
| Street Address |
800 W BROADWAY ST |
| City | MISSOULA |
| State | MT |
| Zip Code | 59802-3944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730469941 | Carla Gren | Pharmacist | 800 W Broadway St, Missoula, MT 59802-3944 | 2011-08-18 |
| 1245531375 | Jade Seifert | Pharmacist | 800 W Broadway St, Missoula, MT 59802-3944 | 2010-11-05 |
| 1255631511 | Danielle Lynn Dauenhauer | Pharmacist | 800 W Broadway St, Missoula, MT 59802-3944 | 2010-11-02 |
| 1457651275 | Scott Roullier | Pharmacist | 800 W Broadway St, Missoula, MT 59802-3944 | 2010-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945921 | Montana Endoscopy Center, Pllc | Clinic/Center | 1930 W Broadway, Ste B, Missoula, MT 59802 | 2020-06-08 |
| 1194364091 | Tommie Lynn Perusich | Nurse Practitioner | 1120 Cedar St., Missoula, MT 59802 | 2019-12-26 |
| 1386122752 | The Hope Health Alliance, Inc. | Case Management | 314 White House Ln, Missoula, MT 59802 | 2018-07-30 |
| 1881181444 | Carol Anne Lesser | Massage Therapist | 1918 Birch St, Missoula, MT 59802 | 2018-04-19 |
| 1528587581 | Missoula Aids Fund, Inc. | Clinic/Center | 1500 W. Broadway Suite A, Missoula, MT 59802 | 2017-09-11 |
| 1942740667 | Gabrielle Shulman | Counselor | 415 N Higgins Ave Ste 14, Missoula, MT 59802 | 2017-02-28 |
| 1053798736 | Endurance Physio | Clinic/Center | 214 E. Main St, Missoula, MT 59802 | 2015-05-01 |
| 1720481971 | Anna Golding | Counselor | 1325 Wyoming Street, Missoula, MONTANA 59802 | 2014-10-02 |
| 1003255803 | Jennifer Dawn Danielson | Speech-Language Pathologist | 2408 Duncan Drive, Missoula, MT 59802 | 2013-06-14 |
| 1437595725 | Partnership Health Center Inc | Clinic/Center | 1150 Sherwood St, Missoula, MT 59802 | 2013-05-14 |
| Find all providers in zip 59802 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104378439 | Shields LLC | Pharmacy | 1315 Wyoming St Ste A, Missoula, MT 59801-1725 | 2016-11-03 |
| 1528469566 | Hearing Aid Institute of Missoula | Pharmacy | 705 S. Reserve St., #b, Missoula, MT 59801 | 2014-09-09 |
| 1194754119 | Missoula Fresh Market LLC | Pharmacy | 3801 S Reserve St, Missoula, MT 59801-7322 | 2006-07-02 |
| 1669410817 | Albertsons LLC | Pharmacy | 3800 S Russell St, Missoula, MT 59801-8525 | 2006-06-02 |
| 1003804436 | Rosauers Supermarkets Inc | Pharmacy | 2350 S Reserve St, Missoula, MT 59801-6447 | 2005-10-10 |
| 1922598481 | University of Montana | Pharmacy | 32 Campus Dr, Skaggs Building 216, Missoula, MT 59812-1522 | 2018-05-10 |
| 1083645113 | K Mart Corp | Pharmacy | 3626 Brooks St, Missoula, MT 59801-7360 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935310 | Sykes Pharmacy Columbia Falls Inc | Pharmacy | 500 12th Ave W Ste 1a, Columbia Falls, MT 59912-3818 | 2020-09-04 |
| 1639625064 | Shopko Stores Operating Co LLC | Pharmacy | 1001 N Center Ave, Hardin, MT 59034-1101 | 2016-08-26 |
| 1043681745 | Walmart Pharmacy | Pharmacy | 443 Osborn Ave, Bigfork, MT 59911-3671 | 2015-10-07 |
| 1164809778 | Credena Health LLC | Pharmacy | 50331a Us Highway 93, Polson, MT 59860-7046 | 2015-05-04 |
| 1962823054 | Vendor Pro Corporation | Pharmacy | 1627 W Main St., Suite 446, Bozeman, MT 59715-4011 | 2013-12-17 |
| 1073853941 | Vans Iga of Dillon Inc | Pharmacy | 110 Southside Blvd, Dillon, MT 59725-3536 | 2013-02-28 |
| 1477850931 | Lakeside Pharmacy LLC | Pharmacy | 7100 Hwy 93 South, Suite A, Lakeside, MT 59922 | 2011-02-18 |
| 1790002566 | Big Sandy Pharmacy Inc | Pharmacy | 158 Johannes Ave, Big Sandy, MT 59520 | 2010-05-03 |
| 1871824300 | Nicolle T Sereday | Pharmacy | 4271 Us Highway 12 E, White Sulphur Springs, MT 59645 | 2010-01-22 |
| 1265676100 | Elkhorn Pharmacy Inc | Pharmacy | 215 N Main, Boulder, MT 59632-0026 | 2009-04-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.