Healthcare Provider Details

I. General information

NPI: 1134351208
Provider Name (Legal Business Name): DAMION KILLSBACK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHEYENNE AVENUE
LAME DEER MT
59043
US

IV. Provider business mailing address

PO BOX 70
LAME DEER MT
59043-0070
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4444
  • Fax: 406-477-4457
Mailing address:
  • Phone: 406-477-4448
  • Fax: 406-477-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4522
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: