Glacier Ridge Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1288 Issued in MT

Legal business name

GLACIER RIDGE PHARMACY INC

Doing business as

Glacier Ridge Pharmacy

Practice address

55 1St Avenue East N
Kalispell, MT 59901-4001

Phone

(406) 755-7979

Fax

(406) 755-7981

NPI assigned

Jun 7, 2009

Last updated

Sep 18, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Renee Wilkonski-Larson, RPHNPI 1033530290

Title

Owner/Manager/Pic

Phone

(406) 370-9877

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Glacier Ridge Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Renee Wilkonski-Larson

  • Pharmacist
  • Kalispell, MT
  • NPI 1033530290
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253232000000",
    "number": "1205062098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 1ST AVENUE EAST N",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599014001",
            "telephone_number": "406-755-7979",
            "fax_number": "406-755-7981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 1ST AVENUE EAST N",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599014001",
            "telephone_number": "406-755-7979",
            "fax_number": "406-755-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER RIDGE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-07",
        "last_updated": "2009-09-18",
        "status": "A",
        "authorized_official_last_name": "WILKONSKI-LARSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "OWNER/MANAGER/PIC",
        "authorized_official_telephone_number": "406-370-9877",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "1288",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205062098",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2783531",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glacier Ridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Glacier Valley Endodontics
• Grace Gladura, OTR/L

• Community/Retail Pharmacy in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Community/Retail Pharmacy in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.