Individual
GARY TIBBETT WOODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
22 LOZEAU LN, SUPERIOR, MT 59872-9622
(406) 822-3859
Mailing address
22 LOZEAU LANE, SUPERIOR, MT 59872
(406) 822-3859
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
3871
MT
183500000X
Pharmacist
Primary
4579
OR
Other
Enumeration date
06/25/2010
Last updated
06/25/2010
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