Healthcare Provider Details

I. General information

NPI: 1639610231
Provider Name (Legal Business Name): LAURIE DAUGHARTY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 DERN DRAW
KALISPELL MT
59901-7139
US

IV. Provider business mailing address

286 DERN DRAW
KALISPELL MT
59901-7139
US

V. Phone/Fax

Practice location:
  • Phone: 406-250-9057
  • Fax:
Mailing address:
  • Phone: 406-250-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3097
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: