Provider Demographics
NPI:1871513465
Name:GIDEL, ANN L (R PH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:GIDEL
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0683
Mailing Address - Country:US
Mailing Address - Phone:406-443-1634
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLIAMS RD
Practice Address - Street 2:PHARMACY DEPARTMENT (119)
Practice Address - City:FORT HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7571
Practice Address - Fax:406-447-7569
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist