Provider Demographics
NPI:1285862318
Name:WARREN, DANA EVE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:EVE
Last Name:WARREN
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 1:950 W FORK PETTY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTON
Mailing Address - State:MT
Mailing Address - Zip Code:59820-9437
Mailing Address - Country:US
Mailing Address - Phone:406-864-0001
Mailing Address - Fax:
Practice Address - Street 1:1003 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4971
Practice Address - Country:US
Practice Address - Phone:406-549-6163
Practice Address - Fax:406-549-1786
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist