Provider Demographics
NPI:1790146678
Name:SONNEMANN, JODEL
Entity Type:Individual
Prefix:
First Name:JODEL
Middle Name:
Last Name:SONNEMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3224
Mailing Address - Country:US
Mailing Address - Phone:406-245-6979
Mailing Address - Fax:406-252-9611
Practice Address - Street 1:670 MAIN ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3224
Practice Address - Country:US
Practice Address - Phone:406-245-6979
Practice Address - Fax:406-252-9611
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC 2936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist