Provider Demographics
NPI:1679870430
Name:PHARMFILL INC
Entity type:Organization
Organization Name:PHARMFILL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCAMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-632-4532
Mailing Address - Street 1:206 STONER LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MT
Mailing Address - Zip Code:59922-8503
Mailing Address - Country:US
Mailing Address - Phone:406-844-2103
Mailing Address - Fax:406-844-2106
Practice Address - Street 1:112 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:HARLOWTON
Practice Address - State:MT
Practice Address - Zip Code:59036-5071
Practice Address - Country:US
Practice Address - Phone:406-632-4532
Practice Address - Fax:406-632-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
MTPHA-PHR-LIC-245563336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1679870430Medicaid
2128820OtherPK