Provider Demographics
NPI:1184023202
Name:SUNDGREN, KARRI JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARRI
Middle Name:JO
Last Name:SUNDGREN
Suffix:
Gender:F
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:PO BOX 579
Mailing Address - Street 2:500 EAST WASHINGTON AVE
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522-0579
Mailing Address - Country:US
Mailing Address - Phone:406-759-5225
Mailing Address - Fax:
Practice Address - Street 1:500 EAST WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522-0579
Practice Address - Country:US
Practice Address - Phone:406-759-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist