Healthcare Provider Details

I. General information

NPI: 1073882817
Provider Name (Legal Business Name): AMBER LYNN CLEGG PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 3RD AVENUE EAST N
KALISPELL MT
59901-4109
US

IV. Provider business mailing address

195 3RD AVENUE EAST N
KALISPELL MT
59901-4109
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-1397
  • Fax: 406-257-5978
Mailing address:
  • Phone: 406-257-1397
  • Fax: 406-257-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number6137
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60223643
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: