Provider Demographics
NPI:1396055562
Name:KALANICK, RICHARD D (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:KALANICK
Suffix:
Gender:M
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:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0297
Mailing Address - Country:US
Mailing Address - Phone:406-390-0566
Mailing Address - Fax:
Practice Address - Street 1:117 W JANEAUX ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3073
Practice Address - Country:US
Practice Address - Phone:406-538-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3199183500000X
MT3475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist