Healthcare Provider Details

I. General information

NPI: 1669986261
Provider Name (Legal Business Name): TERRY L. WHITECOTTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 4TH AVE E
POLSON MT
59860
US

IV. Provider business mailing address

P.O. BOX 880
ST. IGNATIUS MT
59865
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax: 406-745-3529
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-745-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47492
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: