Healthcare Provider Details

I. General information

NPI: 1790358323
Provider Name (Legal Business Name): ANDREW PRYNE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 EDDY AVE
MISSOULA MT
59812-1851
US

IV. Provider business mailing address

634 EDDY AVE
MISSOULA MT
59812-1851
US

V. Phone/Fax

Practice location:
  • Phone: 406-243-5171
  • Fax: 406-243-6185
Mailing address:
  • Phone: 406-243-5171
  • Fax: 406-243-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-79472
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: