Healthcare Provider Details

I. General information

NPI: 1689339129
Provider Name (Legal Business Name): TRISTIN CLOWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 DELL RANGE BLVD
CHEYENNE WY
82009-5453
US

IV. Provider business mailing address

3702 DELL RANGE BLVD
CHEYENNE WY
82009-5453
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-0192
  • Fax: 307-638-5070
Mailing address:
  • Phone: 307-638-0192
  • Fax: 307-638-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number4338
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: