Provider Demographics
NPI:1447791140
Name:VAN ALLEN, MARY SNIPSTEAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SNIPSTEAD
Last Name:VAN ALLEN
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 1:1735 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4013
Mailing Address - Country:US
Mailing Address - Phone:406-585-9155
Mailing Address - Fax:
Practice Address - Street 1:1735 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4013
Practice Address - Country:US
Practice Address - Phone:406-585-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist