MEDICARE: MS. SHARLEEN DEROSIER LANDL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	3704	MT

General Provider Information

NPI Number	:	1114967460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARLEEN DEROSIER LANDL RPH

Provider Business Mailing Address
First Line	:	3890 TRAUFER AVE
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-7461
Country	:	US
Telephone Number	:	406-449-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1892 WILLIAMS
Second Line	:	BOX 190 - PHARMACY
City	:	FORT HARRISON
State	:	MT
Zip	:	59636
Country	:	US
Telephone Number	:	406-447-7571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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