Provider Demographics
NPI:1790815181
Name:FITZGERALD, JOHN ALVIN (RHP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALVIN
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:RHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59337-0005
Mailing Address - Country:US
Mailing Address - Phone:406-557-6180
Mailing Address - Fax:
Practice Address - Street 1:437 MAIN ST.
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MT
Practice Address - Zip Code:59337-0005
Practice Address - Country:US
Practice Address - Phone:406-557-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist