Provider Demographics
NPI:1649029190
Name:ZETTERBERG, KAINE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KAINE
Middle Name:
Last Name:ZETTERBERG
Suffix:
Gender:U
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 1:305 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-8001
Mailing Address - Country:US
Mailing Address - Phone:406-682-4646
Mailing Address - Fax:406-682-6603
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-8001
Practice Address - Country:US
Practice Address - Phone:406-682-4646
Practice Address - Fax:406-682-6603
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT63079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist