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General NPI Number Information
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NPI Number | 1962529255
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Entity Type | Individual
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Provider Name | DOMINIQUE DYNSE PREPUTIN PHARM D, RPH
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 123 5TH AVE STE B
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City | HAVRE
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State | MT
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Zip | 59501-3624
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Country | US
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Telephone | 406-265-9601
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Fax | 406-265-4422
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Provider Business Mailing Address
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Address Line | 2351 ST JOE RD
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City | HAVRE
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State | MT
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Zip | 59501-8095
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Country | US
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Telephone | 406-265-9601
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Fax | 406-265-4422
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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 | 4422
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License Number State | MT
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