Individual
ROMAN MIKHAYLOVICH CHINIKAYLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1003 E BROADWAY ST, MISSOULA, MT 59802-4971
(406) 549-6163
Mailing address
8625 MOURNING DOVE DR, MISSOULA, MT 59808-1024
(406) 239-2757
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA-PHA-LIC-62920
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHA-PHA-LIC-62920
STATE OF MONTANA
MT
Enumeration date
08/11/2019
Last updated
08/11/2019
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