Healthcare Provider Details

I. General information

NPI: 1619447109
Provider Name (Legal Business Name): ROSE OSTEOPATHIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54699 HILLSIDE RD
ST IGNATIUS MT
59865-8915
US

IV. Provider business mailing address

54699 HILLSIDE RD
ST IGNATIUS MT
59865-8915
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-0845
  • Fax: 406-204-3238
Mailing address:
  • Phone: 406-745-0845
  • Fax: 406-204-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DHARMA ROSE
Title or Position: PRESIDENT, DIRECTOR
Credential: DO, MS, RPH, FAIHM
Phone: 406-745-0845