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Suppliers Non-Pharmacy Dispensing Site

Provider NPI: 1033466966

Organization Information:
Organization is Subpart
Authorized Official:  CHRISTINE C. WHITE  OWNER  406-542-2147

Practice Location:
2204 DIXON AVE  MISSOULA, MT 59801-8224 US
Tel: 406-542-2147  Fax: --

Business Mailing Address:
Tel: 310-474-9809  Fax: --

NPI Information:
NPI: 1033466966
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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