Fredrick Thomas Jaqueth, RPH
Individual provider Active NPI Pharmacist · Libby, MT
NPI 1093853335 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1093853335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 884 (MT)
- Practice address
- 906 Montana Ave
Libby, MT 59923-2014 - Phone
- (406) 293-3958
- Fax
- (406) 293-5858
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 884 | MT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Libby Drug P.C | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 884 | MT | Yes |
Addresses
Primary practice location
906 Montana Ave
Libby, MT 59923-2014
Mailing address
906 Montana Ave
Libby, MT 59923-2014
Phone (406) 293-3958
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0220201 | Medicaid | MT |
Other providers in Libby, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.