Provider Demographics
NPI:1154696763
Name:FLYNN, WENDY KAY (RPH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KAY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 N RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1556
Mailing Address - Country:US
Mailing Address - Phone:406-542-3807
Mailing Address - Fax:406-542-3692
Practice Address - Street 1:3220 N RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1556
Practice Address - Country:US
Practice Address - Phone:406-542-3807
Practice Address - Fax:406-542-3692
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist