Provider Demographics
NPI:1750721189
Name:DUNHAM, PHILIP JOHN (RPH)
Entity type:Individual
Prefix:MRS
First Name:PHILIP
Middle Name:JOHN
Last Name:DUNHAM
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 1:2020 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3418
Mailing Address - Country:US
Mailing Address - Phone:406-453-1318
Mailing Address - Fax:406-454-2982
Practice Address - Street 1:2001 10TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2756
Practice Address - Country:US
Practice Address - Phone:406-453-1318
Practice Address - Fax:406-454-3982
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist