Jack Tidaback, RPH

NPI #1255329710 in Sidney, Montana

Provider Information

NPI Number: 1255329710
Entity Type: Individual
Name: Jack Tidaback, RPH
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Pharmacist
Credential: RPH
Enumeration Date: Oct 10, 2005
Last Updated: Jul 8, 2007

Practice Location

Address: 214 14TH AVE SW
City: Sidney
State: Montana
ZIP Code: 59270-3521
Phone: (406) 488-6563

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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