Healthcare Provider Details

I. General information

NPI: 1114967460
Provider Name (Legal Business Name): SHARLEEN DEROSIER LANDL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 WILLIAMS BOX 190 - PHARMACY
FORT HARRISON MT
59636
US

IV. Provider business mailing address

3890 TRAUFER AVE
HELENA MT
59602-7461
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-7571
  • Fax:
Mailing address:
  • Phone: 406-449-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3704
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: