Provider Demographics
NPI:1396869111
Name:BAKKEN, DAVID BRUCE (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:BAKKEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORTH STELLA STREET
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105
Mailing Address - Country:US
Mailing Address - Phone:406-390-0974
Mailing Address - Fax:
Practice Address - Street 1:11 STEILA ST N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1850
Practice Address - Country:US
Practice Address - Phone:406-390-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist