Healthcare Provider Details

I. General information

NPI: 1073653218
Provider Name (Legal Business Name): MONTANA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSU STUDENT HEALTH SERVICE RX 7TH AND GRANT
BOZEMAN MT
59715-0002
US

IV. Provider business mailing address

MSU STUDENT HEALTH SERVICE RX P.O.BOX 173260
BOZEMAN MT
59717
US

V. Phone/Fax

Practice location:
  • Phone: 406-994-5498
  • Fax: 406-994-7071
Mailing address:
  • Phone: 406-994-5498
  • Fax: 406-994-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHA-PHR-LIC-390
License Number StateMT

VIII. Authorized Official

Name: JEAN STERNHAGEN
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 406-994-5498