Provider Demographics
NPI:1902178940
Name:STAPLES, DENNIS (R PH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:STAPLES
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 CATRON ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7993
Mailing Address - Country:US
Mailing Address - Phone:406-585-7575
Mailing Address - Fax:406-585-0459
Practice Address - Street 1:2505 CATRON ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7993
Practice Address - Country:US
Practice Address - Phone:406-585-7575
Practice Address - Fax:406-585-0459
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist