Provider Demographics
NPI:1811398290
Name:BILILE, TRIVA (RPH)
Entity Type:Individual
Prefix:
First Name:TRIVA
Middle Name:
Last Name:BILILE
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 1:1 7TH AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-3202
Mailing Address - Country:US
Mailing Address - Phone:406-883-0565
Mailing Address - Fax:706-883-1878
Practice Address - Street 1:1 7TH AVE E STE C
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-3202
Practice Address - Country:US
Practice Address - Phone:406-883-0565
Practice Address - Fax:706-883-1878
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-3421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist