Individual
VINCENT BLASE BURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
36318 MEMORY LN, POLSON, MT 59860-7265
(406) 883-9221
Mailing address
36318 MEMORY LN, POLSON, MT 59860-7265
(406) 883-9221
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA-PHA-LIC-54888
MT
Other
Enumeration date
07/19/2018
Last updated
07/19/2018
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