Provider Demographics
NPI:1699885509
Name:JORGENSON, SHEILA L (RPH)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:SODERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1330 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-252-0096
Mailing Address - Fax:406-252-3626
Practice Address - Street 1:1330 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-252-0096
Practice Address - Fax:406-252-3626
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT03014-6OtherBLUE CROSS BLUE SHIELD #
MT2704559OtherNABP # OR NCPDP #
MT5600153Medicaid
MT213122Medicaid
MT2704559OtherNABP # OR NCPDP #