Healthcare Provider Details

I. General information

NPI: 1720008238
Provider Name (Legal Business Name): NICHOLAS MARK THENNIS RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 WILLIAMS STREET
FORT HARRISON MT
59636
US

IV. Provider business mailing address

1901 GRANT ST
HELENA MT
59601-1865
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-6410
  • Fax:
Mailing address:
  • Phone: 406-443-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2952
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: