Healthcare Provider Details

I. General information

NPI: 1619579976
Provider Name (Legal Business Name): SHANNON SEXAUER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 PROSPECT AVE
HELENA MT
59601-9741
US

IV. Provider business mailing address

1400 E BROADWAY ST RM A206
HELENA MT
59601-5231
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-3455
  • Fax:
Mailing address:
  • Phone: 406-444-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4887
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: