Provider Demographics
NPI:1376971762
Name:DENTON, COREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DENTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NE MAIN ST
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2080
Mailing Address - Country:US
Mailing Address - Phone:406-538-9262
Mailing Address - Fax:406-538-9795
Practice Address - Street 1:825 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2080
Practice Address - Country:US
Practice Address - Phone:406-538-9262
Practice Address - Fax:406-538-9795
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist