Provider Demographics
NPI:1679767206
Name:CLAUSSEN, EDWARD ALLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:CLAUSSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N PONDERA AVE
Mailing Address - Street 2:#3
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6380
Mailing Address - Country:US
Mailing Address - Phone:406-570-0602
Mailing Address - Fax:
Practice Address - Street 1:213 N PONDERA AVE
Practice Address - Street 2:#3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6380
Practice Address - Country:US
Practice Address - Phone:406-570-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3291183500000X, 1835P1200X
IL51289371183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy