Basic Information
| Provider Information | |||||||||
| NPI: | 1942499843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNESON | ||||||||
| FirstName: | ALVIN | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 5462 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598065462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067215450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 308 MISSION DRIVE | ||||||||
| Address2: | |||||||||
| City: | ST IGNATIUS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
| FaxNumber: | 4067454095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 3030 | MT | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.