Provider Demographics
NPI:1033486220
Name:HATHEWAY, GERARD JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:JOHN
Last Name:HATHEWAY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SWANSON LN
Mailing Address - Street 2:
Mailing Address - City:BONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9754
Mailing Address - Country:US
Mailing Address - Phone:406-546-9805
Mailing Address - Fax:405-244-7959
Practice Address - Street 1:855 SWANSON LN
Practice Address - Street 2:
Practice Address - City:BONNER
Practice Address - State:MT
Practice Address - Zip Code:59823-9754
Practice Address - Country:US
Practice Address - Phone:406-546-9805
Practice Address - Fax:405-244-7959
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist