Glacier Ridge Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1295 Issued in MT

Legal business name

GLACIER RIDGE PHARMACY INC

Doing business as

Alpine Ridge Pharmacy

Practice address

6475 US Highway 93 S
Whitefish, MT 59937-8282

Phone

(406) 862-7434

Fax

(406) 862-7432

NPI assigned

Aug 27, 2009

Last updated

Dec 13, 2013By 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/Pic

Phone

(406) 370-9877

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Alpine 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": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1659504363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6475 US HIGHWAY 93 S",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599378282",
            "telephone_number": "406-862-7434",
            "fax_number": "406-862-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6475 US HIGHWAY 93 S",
            "city": "WHITEFISH",
            "state": "MT",
            "postal_code": "599378282",
            "telephone_number": "406-862-7434",
            "fax_number": "406-862-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER RIDGE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "WILKONSKI-LARSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "406-370-9877",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "1295",
            "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": "1659504363",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2783567",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpine Ridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Whitefish, MT
• Providers in Whitefish, 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 Dec 13, 2013; 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.