Provider Demographics
NPI:1386927515
Name:ENEBO, RENE S (RPH)
Entity type:Individual
Prefix:MS
First Name:RENE
Middle Name:S
Last Name:ENEBO
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 1:2833 CAMPSITE PL
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5426
Mailing Address - Country:US
Mailing Address - Phone:406-830-0440
Mailing Address - Fax:
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-9490
Practice Address - Country:US
Practice Address - Phone:406-830-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist