Provider Demographics
NPI:1811161276
Name:THORMAHLEN, GENINE MARIE (PHARM D, AE-C)
Entity type:Individual
Prefix:
First Name:GENINE
Middle Name:MARIE
Last Name:THORMAHLEN
Suffix:
Gender:F
Credentials:PHARM D, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAMPUS DR
Mailing Address - Street 2:SKAGGS BUILDING, #1522
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-0003
Mailing Address - Country:US
Mailing Address - Phone:406-243-4056
Mailing Address - Fax:406-243-5256
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:SKAGGS BUILDING, #1522
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0004
Practice Address - Country:US
Practice Address - Phone:406-243-4056
Practice Address - Fax:406-243-5256
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist