Healthcare Provider Details

I. General information

NPI: 1477518835
Provider Name (Legal Business Name): KIMBERLY MARIE HURLY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WILSON ST
MILES CITY MT
59301-5094
US

IV. Provider business mailing address

RR 2 BOX 3100
MILES CITY MT
59301-9105
US

V. Phone/Fax

Practice location:
  • Phone: 406-233-2777
  • Fax:
Mailing address:
  • Phone: 406-234-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5831
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: