Provider Demographics
NPI:1972105807
Name:POLK, DEBORAH LYNNE (REGISTERED PHARMACI)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:POLK
Suffix:
Gender:F
Credentials:REGISTERED PHARMACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST BRAODWAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-327-1650
Mailing Address - Fax:406-327-1651
Practice Address - Street 1:500 WEST BRAODWAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-327-1650
Practice Address - Fax:406-327-1651
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-38621835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care