Provider Demographics
NPI:1588624225
Name:BAUMGARTNER, SHIRLEY PATTISON (RPH)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:PATTISON
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-0446
Mailing Address - Country:US
Mailing Address - Phone:406-228-2705
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 67
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3263
Practice Address - Fax:406-353-3266
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2855OtherSTATE LICENSE