Provider Demographics
NPI:1023535507
Name:DOEPKER, ROSE ELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ELLEN
Last Name:DOEPKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4488
Mailing Address - Country:US
Mailing Address - Phone:406-257-4806
Mailing Address - Fax:
Practice Address - Street 1:202 2ND AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4488
Practice Address - Country:US
Practice Address - Phone:406-257-4806
Practice Address - Fax:406-756-5134
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT47074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist