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1730902461 NPI number — ANDREW JOHN EBERLING

NPI Number: 1730902461
Health Care Provider/Practitioner: ANDREW JOHN EBERLING

Information about “1730902461” NPI (ANDREW JOHN EBERLING) exists in 1730902461 in HTML format HTML  |  1730902461 in plain Text format TXT  |  1730902461 in PDF (Portable Document Format) PDF  |  1730902461 in an XML format XML  formats.

NPI Number : 1730902461 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730902461",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EBERLING",
    "FirstName": "ANDREW",
    "MiddleName": "JOHN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2354 38TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSOULA",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59801-8856",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-480-4081",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3687 VETERANS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT HARRISON",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59636-9700",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-215-0347",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/01/2024",
    "LastUpdateDate": "11/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PHA-PHA-LIC-107971",
        "LicenseNumberStateCode": "MT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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