Provider Demographics
NPI:1952340127
Name:MEREDITH, MARK RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RYAN
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 RUBY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9636
Mailing Address - Country:US
Mailing Address - Phone:406-457-2447
Mailing Address - Fax:
Practice Address - Street 1:2475 BROADWAY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-444-2356
Practice Address - Fax:406-447-2407
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist