Provider Demographics
NPI:1174600704
Name:GREGORY STOICK DRUG INC
Entity type:Organization
Organization Name:GREGORY STOICK DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-755-4103
Mailing Address - Street 1:142 E IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4012
Mailing Address - Country:US
Mailing Address - Phone:406-755-4103
Mailing Address - Fax:406-755-4105
Practice Address - Street 1:142 E IDAHO ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4012
Practice Address - Country:US
Practice Address - Phone:406-755-4103
Practice Address - Fax:406-755-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT300670OtherBLUE CROSS BLUE SHIELD
MT0560201Medicaid
MT0210103Medicaid
MT6170290001Medicare NSC