Healthcare Provider Details

I. General information

NPI: 1154696763
Provider Name (Legal Business Name): WENDY KAY FLYNN R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 N RESERVE ST
MISSOULA MT
59808-1556
US

IV. Provider business mailing address

3220 N RESERVE ST
MISSOULA MT
59808-1556
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-3807
  • Fax: 406-542-3692
Mailing address:
  • Phone: 406-542-3807
  • Fax: 406-542-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3583
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: