Healthcare Provider Details

I. General information

NPI: 1548918790
Provider Name (Legal Business Name): EDRE HOLLEY MARCY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN ST
FORSYTH MT
59327-9039
US

IV. Provider business mailing address

PO BOX 289
FORSYTH MT
59327-0289
US

V. Phone/Fax

Practice location:
  • Phone: 406-346-2134
  • Fax:
Mailing address:
  • Phone: 406-346-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-3726
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: