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General NPI Number Information
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NPI Number | 1548450109
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Entity Type | Individual
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Provider Name | DAVID ALLEN BRISTOL R.PH.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 906 MONTANA AVE
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City | LIBBY
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State | MT
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Zip | 59923-2014
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Country | US
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Telephone | 406-293-3958
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 JAMIE ANN DR
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City | MISSOULA
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State | MT
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Zip | 59803-2789
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Country | US
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Telephone | 406-251-0060
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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 | 3591
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License Number State | MT
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