1881613404 NPI number — MS. LORI BOLDT FITZGERALD PHARM D

Table of content: MS. LORI BOLDT FITZGERALD PHARM D (NPI 1881613404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881613404 NPI number — MS. LORI BOLDT FITZGERALD PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZGERALD
Provider First Name:
LORI
Provider Middle Name:
BOLDT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881613404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 BLAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59601-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-449-5602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1892 WILLIAMS STREET
Provider Second Line Business Practice Location Address:
PHARMACY 119
Provider Business Practice Location Address City Name:
FORT HARRISON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-447-7572
Provider Business Practice Location Address Fax Number:
406-447-7569
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  3287 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 114448-6 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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