Vincent Blase Burt
Individual provider Active NPI Pharmacist · Polson, MT
NPI 1477039758 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1477039758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PHA-PHA-LIC-54888 (MT)
- Practice address
- 36318 Memory LN
Polson, MT 59860-7265 - Phone
- (406) 883-9221
- NPI assigned
- Jul 19, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHA-PHA-LIC-54888 | MT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PHA-PHA-LIC-54888 | MT | Yes |
Addresses
Primary practice location
36318 Memory LN
Polson, MT 59860-7265
Mailing address
36318 Memory LN
Polson, MT 59860-7265
Phone (406) 883-9221
Other providers in Polson, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2018. 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.