Provider Demographics
NPI:1710170097
Name:KOMMERS, ROSE M (RPH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:KOMMERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:209 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4245
Mailing Address - Country:US
Mailing Address - Phone:406-453-5939
Mailing Address - Fax:
Practice Address - Street 1:209 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4245
Practice Address - Country:US
Practice Address - Phone:406-453-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist