| NPI | 1912462326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE HABEL Pharmacist In Charge 307-786-2222 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 333600000X Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-09-06 |