| NPI | 1578268413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE HABEL Pharmacy Owner 307-786-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies | |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition | |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2024-08-07 |