Provider Demographics
NPI:1861249245
Name:LLOYD, CASSIDY R
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:R
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 RIATA RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5204
Mailing Address - Country:US
Mailing Address - Phone:406-249-7625
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD STE 146
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7401
Practice Address - Country:US
Practice Address - Phone:406-249-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-32214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist