Provider Demographics
NPI:1649570599
Name:PRIBYL, CHARLES DUANE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DUANE
Last Name:PRIBYL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3827
Mailing Address - Country:US
Mailing Address - Phone:406-443-4508
Mailing Address - Fax:406-443-3517
Practice Address - Street 1:611 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3827
Practice Address - Country:US
Practice Address - Phone:406-443-4508
Practice Address - Fax:406-443-3517
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist