Edwin Bangen
Individual provider Active NPI Pharmacist · Missoula, MT
NPI 1962864082 · NPPES record last updated Mar 28, 2016
Key facts
- NPI
- 1962864082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2615 (MT)
- Practice address
- 2205 Oxford St
Missoula, MT 59801-7936 - Phone
- (406) 549-5127
- Fax
- (406) 721-8117
- NPI assigned
- Mar 28, 2016
- 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 |
|---|---|---|---|
| 2615 | MT | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2615 | MT | Yes |
Addresses
Primary practice location
2205 Oxford St
Missoula, MT 59801-7936
Mailing address
2205 Oxford St
Missoula, MT 59801-7936
Phone (406) 549-5127
NPI Registry JSON
{
"created_epoch": "1459123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459123200000",
"number": "1962864082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2205 OXFORD ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598017936",
"telephone_number": "406-549-5127",
"fax_number": "406-721-8117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2205 OXFORD ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598017936",
"telephone_number": "406-549-5127",
"fax_number": "406-721-8117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANGEN",
"first_name": "EDWIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-28",
"last_updated": "2016-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MT",
"license": "2615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2016. 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.