Provider Demographics
NPI:1215388319
Name:MAJOR, MANDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:MAJOR
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 1:2350 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6447
Mailing Address - Country:US
Mailing Address - Phone:406-721-5330
Mailing Address - Fax:406-721-4832
Practice Address - Street 1:2350 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6447
Practice Address - Country:US
Practice Address - Phone:406-721-5330
Practice Address - Fax:406-721-4832
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT38457OtherSTATE PHARMACIST LICENSE