MEDICARE: POMALO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1942157276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMALO PLLC

Provider Business Mailing Address
First Line	:	5832 KERR DR
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-3028
Country	:	US
Telephone Number	:	406-213-5166
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S ORANGE ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-2525
Country	:	US
Telephone Number	:	406-213-5166
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	BROOKE VICTORIA CONRADY
Credential	:	APRN
Telephone Number	:	406-593-0755

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “POMALO PLLC ” Practice Location

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