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NPI Code Detail

MEDICARE: NANCY SUSAN ANDERSEN RPH

MEDICARE: NANCY SUSAN ANDERSEN RPH
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
1183500000XPharmacist2736WY

General Provider Information

NPI Number : 1790093839
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY SUSAN ANDERSEN RPH
Provider Business Mailing Address
First Line : 2531 FOOTHILL BLVD
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-4744
Country : US
Telephone Number : 307-362-1841
Fax Number : 307-382-2197
Provider Business Practice Location Address
First Line : 2531 FOOTHILL BLVD
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-4744
Country : US
Telephone Number : 307-362-1841
Fax Number : 307-382-2197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2010
Last Update Date : 09/23/2010

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Directions to “ NANCY SUSAN ANDERSEN RPH” Practice Location

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