Provider Demographics
NPI:1275292617
Name:BOSIC-REINIGER, JADE ALEXANDRIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:ALEXANDRIA
Last Name:BOSIC-REINIGER
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 1:3906 BELLECREST DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8908
Mailing Address - Country:US
Mailing Address - Phone:406-212-9504
Mailing Address - Fax:
Practice Address - Street 1:6475 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8282
Practice Address - Country:US
Practice Address - Phone:406-212-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-79676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist