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Suppliers Non-Pharmacy Dispensing Site

Provider NPI: 1114245867

Organization Information:
Organization Name:  SWEETWATER, LLC
Organization is not Subpart
Authorized Official:  GABRIEL  MCMURRAY  OWNER  406-541-0420

Practice Location:
5707 W HARRIER DR  MISSOULA, MT 59808-5345 US
Tel: 406-541-0420  Fax: --

Business Mailing Address:
5707 W HARRIER DR  MISSOULA, MT 59808-5345 US
Tel: 406-541-0420  Fax: --

NPI Information:
NPI: 1114245867
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Non-Pharmacy Dispensing Site

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 332900000X





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