Provider Demographics
NPI:1346850989
Name:WETSCH, TOREY ANN
Entity Type:Individual
Prefix:
First Name:TOREY
Middle Name:ANN
Last Name:WETSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W BROADWAY ST STE 101-325
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4136
Mailing Address - Country:US
Mailing Address - Phone:406-314-3679
Mailing Address - Fax:
Practice Address - Street 1:2100 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6649
Practice Address - Country:US
Practice Address - Phone:406-728-2089
Practice Address - Fax:406-728-9267
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-71114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist