Provider Demographics
NPI:1285035451
Name:DRUYVESTEIN, KEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:DRUYVESTEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50331 US HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7046
Mailing Address - Country:US
Mailing Address - Phone:406-883-3838
Mailing Address - Fax:406-883-3806
Practice Address - Street 1:50331 US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7046
Practice Address - Country:US
Practice Address - Phone:406-883-3838
Practice Address - Fax:406-883-3806
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist