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General NPI Number Information
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NPI Number | 1669132379
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Entity Type | Organization
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Legal Business Name | JAK SHIELDS, LLC
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 111 N HIGGINS AVE STE 5
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City | MISSOULA
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State | MT
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Zip | 59802-4494
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Country | US
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Telephone | 406-542-2888
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Fax | 406-542-9380
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Provider Business Mailing Address
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Address Line | 111 N HIGGINS AVE STE 101
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City | MISSOULA
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State | MT
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Zip | 59802-4437
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Country | US
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Telephone | 406-542-2888
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Fax | 406-542-9380
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Authorized Official
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Title or Position | OWNER/PIC
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Name | KELLY MARIE SHIELDS
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Credential | PHARM.D
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Telephone | 406-542-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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