Healthcare Provider Details

I. General information

NPI: 1871003483
Provider Name (Legal Business Name): CHADWICK BARDWELL SOMMERS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 FORT ST
BUFFALO WY
82834-1805
US

IV. Provider business mailing address

385 CONRAD
BUFFALO WY
82834-2553
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-7003
  • Fax:
Mailing address:
  • Phone: 970-640-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberTL3805
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: