Provider Demographics
NPI:1114228772
Name:CLARK, RITA CUNNEEN (PHARMD RPH)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:CUNNEEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7322
Mailing Address - Country:US
Mailing Address - Phone:406-251-5415
Mailing Address - Fax:406-251-8663
Practice Address - Street 1:3801 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7322
Practice Address - Country:US
Practice Address - Phone:406-251-5415
Practice Address - Fax:406-251-8663
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist