Provider Demographics
NPI:1205456043
Name:HUSTON, MATTHEW JAMES (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:HUSTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BAKER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-862-7070
Mailing Address - Fax:406-862-7088
Practice Address - Street 1:1111 BAKER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-862-7070
Practice Address - Fax:406-862-7088
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT47257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist