Provider Demographics
NPI:1134351208
Name:KILLSBACK, DAMION (PHARMD)
Entity type:Individual
Prefix:
First Name:DAMION
Middle Name:
Last Name:KILLSBACK
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043-0070
Mailing Address - Country:US
Mailing Address - Phone:406-477-4448
Mailing Address - Fax:406-477-4457
Practice Address - Street 1:100 CHEYENNE AVENUE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4444
Practice Address - Fax:406-477-4457
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist