Provider Demographics
NPI:1326301672
Name:MONTER, MARY THERESE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:MONTER
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 1:1515 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1149
Mailing Address - Country:US
Mailing Address - Phone:509-571-2513
Mailing Address - Fax:509-529-3788
Practice Address - Street 1:450 N WILBUR AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2254
Practice Address - Country:US
Practice Address - Phone:509-529-3706
Practice Address - Fax:509-529-3788
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00065809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist