Provider Demographics
NPI:1952710972
Name:MCGLOIN, KELLY MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:MCGLOIN
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 1:3901 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6802
Mailing Address - Country:US
Mailing Address - Phone:406-494-1225
Mailing Address - Fax:406-494-1629
Practice Address - Street 1:3901 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6802
Practice Address - Country:US
Practice Address - Phone:406-494-1225
Practice Address - Fax:406-494-1629
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist