Healthcare Provider Details

I. General information

NPI: 1295986875
Provider Name (Legal Business Name): GERALD LYNN PAXTON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 BRIDGER DR
GREEN RIVER WY
82935-5879
US

IV. Provider business mailing address

905 BRIDGER DR
GREEN RIVER WY
82935-5879
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-7841
  • Fax: 307-875-0166
Mailing address:
  • Phone: 307-875-7841
  • Fax: 307-875-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2502
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: