Provider Demographics
NPI:1659467652
Name:MAURER, JOELLEN LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:LYNN
Last Name:MAURER
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 1:263 MT HIGHWAY 528
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-7033
Mailing Address - Country:US
Mailing Address - Phone:406-525-3610
Mailing Address - Fax:406-768-5109
Practice Address - Street 1:67 H ST. E
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-0067
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:406-768-5109
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03217879183500000X
MT5880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist