Provider Demographics
NPI:1710274063
Name:GRUTSCH, MOLLY BETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BETH
Last Name:GRUTSCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 N RESERVE ST
Mailing Address - Street 2:T-0885
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1317
Mailing Address - Country:US
Mailing Address - Phone:406-728-9463
Mailing Address - Fax:
Practice Address - Street 1:2420 N RESERVE ST
Practice Address - Street 2:T-0885
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1317
Practice Address - Country:US
Practice Address - Phone:406-728-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist