Provider Demographics
NPI:1831805902
Name:BLENKNER, REBECCA MAE ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAE ROSE
Last Name:BLENKNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH ST W STE B
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1804
Mailing Address - Country:US
Mailing Address - Phone:406-867-4141
Mailing Address - Fax:406-294-0040
Practice Address - Street 1:10 4TH ST W STE B
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1804
Practice Address - Country:US
Practice Address - Phone:406-867-4141
Practice Address - Fax:406-294-0040
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-92119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist