Healthcare Provider Details

I. General information

NPI: 1952340127
Provider Name (Legal Business Name): MARK RYAN MEREDITH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 BROADWAY
HELENA MT
59601
US

IV. Provider business mailing address

55 RUBY MOUNTAIN RD
CLANCY MT
59634-9636
US

V. Phone/Fax

Practice location:
  • Phone: 406-444-2356
  • Fax: 406-447-2407
Mailing address:
  • Phone: 406-457-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3746
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: