Healthcare Provider Details

I. General information

NPI: 1770409294
Provider Name (Legal Business Name): DANIELLE LAURIDSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

IV. Provider business mailing address

3055 BREEZE LN # A
BOZEMAN MT
59718-3402
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-1208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-47352
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: