Healthcare Provider Details

I. General information

NPI: 1376845362
Provider Name (Legal Business Name): HEATHER PEACOCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FOUR MILE DR SUITE 3
KALISPELL MT
59901-2632
US

IV. Provider business mailing address

1235 CLAYTON LN
COLUMBIA FALLS MT
59912-4495
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-0440
  • Fax: 406-752-0443
Mailing address:
  • Phone: 406-892-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6324
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: