Provider Demographics
NPI:1114967460
Name:LANDL, SHARLEEN DEROSIER (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHARLEEN
Middle Name:DEROSIER
Last Name:LANDL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 TRAUFER AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7461
Mailing Address - Country:US
Mailing Address - Phone:406-449-5583
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLIAMS
Practice Address - Street 2:BOX 190 - PHARMACY
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7571
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist