MEDICARE: KEEGAN SYVRUD PHARMD

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	PHA-PHA-LIC-98049	MT

General Provider Information

NPI Number	:	1902683881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEEGAN SYVRUD PHARMD

Provider Business Mailing Address
First Line	:	1418 FRONT ST
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-8884
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 FRONT ST
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-8884
Country	:	US
Telephone Number	:	406-622-5588
Fax Number	:

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	10/16/2023

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