Healthcare Provider Details

I. General information

NPI: 1871594895
Provider Name (Legal Business Name): SHATTO DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E RICHARDS ST
DOUGLAS WY
82633-2934
US

IV. Provider business mailing address

PO BOX 705
DOUGLAS WY
82633-0705
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-5077
  • Fax: 307-358-6301
Mailing address:
  • Phone: 307-358-5077
  • Fax: 307-358-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1995
License Number StateWY

VIII. Authorized Official

Name: MR. TANNER B SHATTO
Title or Position: CO-OWNER
Credential:
Phone: 307-358-5077