Healthcare Provider Details

I. General information

NPI: 1487047122
Provider Name (Legal Business Name): GLENROCK HSOPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 04/03/2025
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WEST BIRCH
GLENROCK WY
82637-0786
US

IV. Provider business mailing address

PO BOX 786
GLENROCK WY
82637-0786
US

V. Phone/Fax

Practice location:
  • Phone: 307-436-9206
  • Fax: 307-436-9730
Mailing address:
  • Phone: 307-436-9206
  • Fax: 307-436-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateWY

VIII. Authorized Official

Name: MRS. ASHLEY MARIE OVIEDO-LOPEZ
Title or Position: ADMINISTRATOR
Credential: FNPC
Phone: 307-436-9206