Provider Demographics
NPI:1962529255
Name:PREPUTIN, DOMINIQUE DYNSE (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:DYNSE
Last Name:PREPUTIN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 ST JOE RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-8095
Mailing Address - Country:US
Mailing Address - Phone:406-265-9601
Mailing Address - Fax:406-265-4422
Practice Address - Street 1:123 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3624
Practice Address - Country:US
Practice Address - Phone:406-265-9601
Practice Address - Fax:406-265-4422
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist