Healthcare Provider Details

I. General information

NPI: 1104403369
Provider Name (Legal Business Name): BRETT AMESTOY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 E BROADWAY ST
HELENA MT
59601-4928
US

IV. Provider business mailing address

2013 GOLD RUSH AVE
HELENA MT
59601-5816
US

V. Phone/Fax

Practice location:
  • Phone: 406-444-2350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA-PHA-LIC-63004
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: