Provider Demographics
NPI:1144766031
Name:HILDE, BRANDY JO (RPH)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:HILDE
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 1:127 OUT OF BOUNDS TRL
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8821
Mailing Address - Country:US
Mailing Address - Phone:907-738-9253
Mailing Address - Fax:
Practice Address - Street 1:1401 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2309
Practice Address - Country:US
Practice Address - Phone:406-293-3784
Practice Address - Fax:406-293-9546
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-39595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist