Healthcare Provider Details

I. General information

NPI: 1326873407
Provider Name (Legal Business Name): HEATHER MAY KLUG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 7650 EAST
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 9
CROW AGENCY MT
59022-0009
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9961764
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: