Provider Demographics
NPI:1245548437
Name:BURDEAU, AMBER G (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:G
Last Name:BURDEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-3529
Practice Address - Street 1:5 4TH AVE. E
Practice Address - Street 2:
Practice Address - City:POISON
Practice Address - State:MT
Practice Address - Zip Code:59860-4123
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-3529
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6259183500000X
WAPH60164193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist