Provider Demographics
NPI:1740641992
Name:PRESCOTT, GARY (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PRESCOTT
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 1:501 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-2823
Mailing Address - Country:US
Mailing Address - Phone:406-873-2055
Mailing Address - Fax:
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-2823
Practice Address - Country:US
Practice Address - Phone:406-873-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist