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General NPI Number Information
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NPI Number | 1245433119
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Entity Type | Individual
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Provider Name | STEPHEN E MATHISON REGPH
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 W IDAHO ST
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City | KALISPELL
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State | MT
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Zip | 59901-3844
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Country | US
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Telephone | 406-257-7564
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Fax |
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Provider Business Mailing Address
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Address Line | 140 NORTHRIDGE DR
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City | KALISPELL
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State | MT
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Zip | 59901-2635
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Country | US
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Telephone | 406-752-8059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2407
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License Number State | MT
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