Healthcare Provider Details

I. General information

NPI: 1265434278
Provider Name (Legal Business Name): JAMES W NORMARK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PEACEMAKER PL
SEELEY LAKE MT
59868-1123
US

IV. Provider business mailing address

PO BOX 1123 264 PEACEMAKER PLACE
SEELEY LAKE MT
59868-1123
US

V. Phone/Fax

Practice location:
  • Phone: 406-210-2471
  • Fax:
Mailing address:
  • Phone: 406-210-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5649
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3258
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6954
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: