Provider Demographics
NPI:1295357150
Name:BERGQUIST, BRYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BERGQUIST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HIDDEN COVE CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5782
Mailing Address - Country:US
Mailing Address - Phone:206-650-2932
Mailing Address - Fax:
Practice Address - Street 1:603 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3885
Practice Address - Country:US
Practice Address - Phone:406-442-9800
Practice Address - Fax:406-443-5889
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist