MEDICARE: CHEYENNE MINTON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0024540	WI
2	183500000X	Pharmacist	0024540	CO

General Provider Information

NPI Number	:	1588436133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE MINTON PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 1053
Second Line	:
City	:	DILLON
State	:	CO
Zip	:	80435-1025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 N ROCHESTER ST
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-8738
Country	:	US
Telephone Number	:	262-363-1680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	06/01/2026

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