Provider Demographics
NPI:1265733919
Name:KISH, JO ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ANN
Last Name:KISH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:BILILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:910 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2500
Mailing Address - Country:US
Mailing Address - Phone:406-587-0608
Mailing Address - Fax:406-587-0164
Practice Address - Street 1:910 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2500
Practice Address - Country:US
Practice Address - Phone:406-587-0608
Practice Address - Fax:406-587-0164
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist