Provider Demographics
NPI:1528301611
Name:GARNETT, BRIAN EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:GARNETT
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 1:11461 STELLA BLUE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8492
Mailing Address - Country:US
Mailing Address - Phone:406-493-8737
Mailing Address - Fax:
Practice Address - Street 1:11461 STELLA BLUE DR
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8492
Practice Address - Country:US
Practice Address - Phone:406-493-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14875183500000X
WA22225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist