Provider Demographics
NPI:1144669235
Name:VOLBERDING, THOMAS MARTIN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARTIN
Last Name:VOLBERDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2729
Mailing Address - Country:US
Mailing Address - Phone:406-563-9174
Mailing Address - Fax:406-563-9388
Practice Address - Street 1:1300 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2729
Practice Address - Country:US
Practice Address - Phone:406-563-9174
Practice Address - Fax:406-563-9388
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist