Healthcare Provider Details

I. General information

NPI: 1992809552
Provider Name (Legal Business Name): STARLA MARIE BLANK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 E BROADWAY ST
HELENA MT
59601-4928
US

IV. Provider business mailing address

2475 E BROADWAY ST
HELENA MT
59601-4928
US

V. Phone/Fax

Practice location:
  • Phone: 406-444-2356
  • Fax:
Mailing address:
  • Phone: 406-444-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3222
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: