Healthcare Provider Details

I. General information

NPI: 1790697399
Provider Name (Legal Business Name): CHANCE DAKOTA FRATER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 7650 E
CROW AGENCY MT
59022
US

IV. Provider business mailing address

212 11TH ST W
HARDIN MT
59034-1213
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3478
  • Fax:
Mailing address:
  • Phone: 937-597-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031993A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: