Provider Demographics
NPI:1518486869
Name:BODLE, BARRY WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WILLIAM
Last Name:BODLE
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 1:3958 EVENSON LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6350
Mailing Address - Country:US
Mailing Address - Phone:907-750-8896
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?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-42667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist