Provider Demographics
NPI:1992234728
Name:WEBBER, ALYSE DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:DANIELLE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:DANIELLE
Other - Last Name:ROPPEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-1523
Mailing Address - Country:US
Mailing Address - Phone:406-778-3839
Mailing Address - Fax:
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-9013
Practice Address - Country:US
Practice Address - Phone:406-778-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT35050OtherBOARD OF PHARMACY