| NPI | 1164812475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS BECK Pharmacist In Charge 307-746-2425 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY R10140) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2023-05-03 |