Provider Demographics
NPI:1962811505
Name:RODEGHIERO, JEFFREY (PHARM D)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:RODEGHIERO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BERNHARDT RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-8702
Mailing Address - Country:US
Mailing Address - Phone:406-628-1762
Mailing Address - Fax:406-628-1764
Practice Address - Street 1:101 BERNHARDT RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-8702
Practice Address - Country:US
Practice Address - Phone:406-628-1762
Practice Address - Fax:406-628-1764
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist