Provider Demographics
NPI:1881871705
Name:NIEBUR, MARCIE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:LYNN
Last Name:NIEBUR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-7133
Mailing Address - Country:US
Mailing Address - Phone:406-322-5652
Mailing Address - Fax:406-322-4960
Practice Address - Street 1:133 W 5TH AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7133
Practice Address - Country:US
Practice Address - Phone:406-322-5652
Practice Address - Fax:406-322-4960
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist