=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861264319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOBBIE JO MCFADDEN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2023
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 12TH AVE N STE 503E
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-237-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7119 WHITETAIL LN
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-6276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-698-0820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | PHA-PHA-LIC-4613
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------