Provider Demographics
NPI:1598065195
Name:RATZBURG, ERNEST MALDEN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:MALDEN
Last Name:RATZBURG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:ERNEST
Other - Middle Name:MALDEN
Other - Last Name:RATZBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:40774 MT HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7745
Mailing Address - Country:US
Mailing Address - Phone:406-883-3674
Mailing Address - Fax:
Practice Address - Street 1:40774 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7745
Practice Address - Country:US
Practice Address - Phone:406-883-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist