Provider Demographics
NPI:1548918790
Name:MARCY, EDRE HOLLEY (RPH)
Entity type:Individual
Prefix:
First Name:EDRE
Middle Name:HOLLEY
Last Name:MARCY
Suffix:
Gender:F
Credentials:RPH
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 289
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0289
Mailing Address - Country:US
Mailing Address - Phone:406-346-2134
Mailing Address - Fax:
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-9039
Practice Address - Country:US
Practice Address - Phone:406-346-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-3726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist