Healthcare Provider Details

I. General information

NPI: 1285862318
Provider Name (Legal Business Name): DANA EVE WARREN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E BROADWAY ST
MISSOULA MT
59802-4971
US

IV. Provider business mailing address

950 W FORK PETTY CREEK RD
ALBERTON MT
59820-9437
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-6163
  • Fax: 406-549-1786
Mailing address:
  • Phone: 406-864-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3883
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: