Provider Demographics
NPI:1114248648
Name:GATES, SUZANNE T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:T
Last Name:GATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:T
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40770 MT HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7745
Mailing Address - Country:US
Mailing Address - Phone:406-340-6042
Mailing Address - Fax:
Practice Address - Street 1:#5 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59865
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-3529
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00054148183500000X
MTPHA-PHA-LIC-42710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist