Granite Pharmacy Missoula, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

18801 Issued in MT

Legal business name

GRANITE PHARMACY MISSOULA, LLC

Doing business as

Granite Pharmacy Missoula

Practice address

2230 27TH Ave. West
Suite 2
Missoula, MT 59804

Phone

(406) 926-2940

Fax

(406) 926-2944

NPI assigned

Aug 12, 2013

Organization subpart

No

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

Authorized official

Name

Tina Koerner

Title

Owner

Phone

(406) 926-2941

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Granite Pharmacy Missoula Doing business as

Medicare fee-for-service enrollment

Enrolled in MT2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 1

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

• Daniel Dixon Berk

  • Pharmacist
  • Missoula, MT
  • NPI 1881349108
  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1447683651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 27TH AVE. WEST",
            "address_2": "SUITE 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59804",
            "telephone_number": "406-926-2940",
            "fax_number": "406-926-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 27TH AVE. WEST",
            "address_2": "SUITE 2",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59804",
            "telephone_number": "406-926-2940",
            "fax_number": "406-926-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE PHARMACY MISSOULA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "KOERNER",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-926-2941"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "18801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT PHARMACY LICENSE",
            "identifier": "PHA-PHR-LIC-18801",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447683651",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granite Pharmacy Missoula",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joy Anne Graham, LCPC
• Trail Ellison Gralenski
• Karen Sue Granberry, PT
• Grandma'S House Inc.
• Granite Counseling of Montana, LLC
• Francienne Linda-Ann Grantsaris, FNP-C
• Nicole Gratch, LCSW
• Grateful Insight LLC
• Tessa Caroleen Gravante, OTR/L
• Meghan Rose Graves, RBT

• Community/Retail Pharmacy in Missoula, MT
• Providers in Missoula, 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 Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.