NPIMap

Organization Active NPI

WDP Inc

  • Community/Retail Pharmacy
  • Havre, MT
National Provider Identifier
1356583330
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1283 Issued in MT
Legal business name
WDP INC
Practice address
123 5TH Ave
Ste B
Havre, MT 59501-3623
Phone
(406) 265-9601
Fax
(406) 265-4422
NPI assigned
Apr 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
Dominique PreputinNPI 1962529255
Title
Owner
Phone
(406) 265-9601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 1283 MT Primary

Addresses

Primary practice location

123 5TH Ave
Ste B
Havre, MT 59501-3623

Mailing address

PO Box 631
Havre, MT 59501-0631
Phone (406) 265-9601

Other identifiers 2

IdentifierTypeStateIssuer
2120028OtherPK
1356583330MedicaidMT

Other names 1

  • Western Drug Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111024000390 MT Part B Supplier - Mass Immunization (Roster Biller Only) 4789883869 Practice locations: Havre, MT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1356583330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631",
            "city": "HAVRE",
            "state": "MT",
            "postal_code": "595010631",
            "telephone_number": "406-265-9601",
            "fax_number": "406-265-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 5TH AVE",
            "address_2": "STE B",
            "city": "HAVRE",
            "state": "MT",
            "postal_code": "595013623",
            "telephone_number": "406-265-9601",
            "fax_number": "406-265-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WDP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "PREPUTIN",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-265-9601"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "1283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120028",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356583330",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Drug Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Drug Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Havre, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.