Healthcare Provider Details

I. General information

NPI: 1477325553
Provider Name (Legal Business Name): HOSKINSON ANCILLARY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HIGHWAY 50
GILLETTE WY
82718-9330
US

IV. Provider business mailing address

469 HIGHWAY 50
GILLETTE WY
82718-9330
US

V. Phone/Fax

Practice location:
  • Phone: 307-387-9850
  • Fax:
Mailing address:
  • Phone: 307-387-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HOSKINSON
Title or Position: PRESIDENT/OWNER, CHIEF MEDICAL OFFI
Credential: D.O.
Phone: 307-387-9850