Provider Demographics
NPI:1215327333
Name:DEPNER, KORI
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:DEPNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1909
Mailing Address - Country:US
Mailing Address - Phone:406-452-6461
Mailing Address - Fax:406-452-4833
Practice Address - Street 1:2515 6TH AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-1909
Practice Address - Country:US
Practice Address - Phone:406-452-6461
Practice Address - Fax:406-452-4833
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist