Timothy Polacheck
Individual provider Active NPI Pharmacist · Laurel, MT
NPI 1932623923 · NPPES record last updated Aug 1, 2017
Key facts
- NPI
- 1932623923
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 43152 (MT)
- Practice address
- 101 Bernhardt Rd
Laurel, MT 59044 - Phone
- (406) 628-1762
- NPI assigned
- Aug 1, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 43152 | MT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 43152 | MT | Yes |
Addresses
Primary practice location
101 Bernhardt Rd
Laurel, MT 59044
Mailing address
101 Bernhardt Rd
Laurel, MT 59044-8702
Other providers in Laurel, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2017. 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.