Provider Demographics
NPI:1760585277
Name:CLAIRMONT, BEVERLY J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:J
Last Name:CLAIRMONT
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 1:705 EMMERLING
Mailing Address - Street 2:PO BOX 428
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-0428
Mailing Address - Country:US
Mailing Address - Phone:701-549-2661
Mailing Address - Fax:701-549-2664
Practice Address - Street 1:1102 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-0428
Practice Address - Country:US
Practice Address - Phone:701-549-2661
Practice Address - Fax:701-549-2664
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4424183500000X
WAPH00010340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4424OtherPHARMACIST LISCENCE NUMBE