NPIMap

Organization Active NPI

Superior Specialty Pharmacy of Montana, LLC

  • Compounding Pharmacy
  • Kalispell, MT
National Provider Identifier
1679977433
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
Legal business name
SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLC
Practice address
20 Four Mile Dr Ste 4
Kalispell, MT 59901-2644
Phone
(406) 752-0499
Fax
(406) 752-0498
NPI assigned
Oct 22, 2014
Organization subpart
Yes
Parent organization
SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Authorized official

Name
David Grady
Title
Managing Member/Owner
Phone
(406) 752-0440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 1209 MT
Compounding Pharmacy 3336C0004X Primary

Addresses

Primary practice location

20 Four Mile Dr Ste 4
Kalispell, MT 59901-2644

Mailing address

1600 Whitefish Stage Road
Suite #2
Kalispell, MT 59901
Phone (406) 752-0499

Other identifiers 1

IdentifierTypeStateIssuer
2148091OtherPK

Other names 2

  • Big Sky Specialty Compounding Doing business as
  • Big Sky Specialty Compoundng Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Superior Specialty Pharmacy3 organizations share this tax ID, including this one
Part of
Superior Specialty Pharmacy

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1600 Whitefish Stage
Ste 2
Kalispell, MT 59901

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569196800000",
    "number": "1679977433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WHITEFISH STAGE ROAD",
            "address_2": "SUITE #2",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "59901",
            "telephone_number": "406-752-0499",
            "fax_number": "406-752-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FOUR MILE DR STE 4",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012644",
            "telephone_number": "406-752-0499",
            "fax_number": "406-752-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUPERIOR SPECIALTY PHARMACY OF MONTANA, LLC",
        "enumeration_date": "2014-10-22",
        "last_updated": "2019-09-23",
        "status": "A",
        "authorized_official_last_name": "GRADY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "406-752-0440"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "1209",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148091",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Big Sky Specialty Compounding",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Big Sky Specialty Compoundng",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Big Sky Specialty Compoundng",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; 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.