Provider Demographics
NPI:1629174883
Name:ROSENBAUM, ERIC LOUIS (RPH, PHARM MNGR)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LOUIS
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:RPH, PHARM MNGR
Other - Prefix:MRS
Other - First Name:KARI
Other - Middle Name:WAR
Other - Last Name:VONDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER
Mailing Address - Street 1:1313 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2900
Mailing Address - Country:US
Mailing Address - Phone:406-222-7332
Mailing Address - Fax:
Practice Address - Street 1:1313 W PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0219778Medicaid
MT2703331OtherNABP
MTBK9427964OtherDEA NUMBER
MTBK9427964OtherDEA NUMBER