Provider First Line Business Practice Location Address: 
UNIVERSITY OF MONTANA SCHOOL OF PHARMACY
    Provider Second Line Business Practice Location Address: 
32 CAMPUS DR., #1522
    Provider Business Practice Location Address City Name: 
MISSOULA
    Provider Business Practice Location Address State Name: 
MT
    Provider Business Practice Location Address Postal Code: 
59812-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
406-243-4631
    Provider Business Practice Location Address Fax Number: 
406-243-4353
    Provider Enumeration Date: 
03/31/2006