Provider Demographics
NPI:1679533426
Name:MACKLIN, ROSE (PHARMD, BCPS)
Entity Type:Individual
Prefix:PROF
First Name:ROSE
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 ELDORA LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2800
Mailing Address - Country:US
Mailing Address - Phone:406-251-4373
Mailing Address - Fax:
Practice Address - Street 1:2687 PALMER ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1710
Practice Address - Country:US
Practice Address - Phone:406-728-8848
Practice Address - Fax:406-327-3727
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist