Healthcare Provider Details

I. General information

NPI: 1275742009
Provider Name (Legal Business Name): K. DIANE BOCHE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 GREYBULL AVE
GREYBULL WY
82426-2038
US

IV. Provider business mailing address

1625 N SMITH RD
RIVERTON WY
82501-9436
US

V. Phone/Fax

Practice location:
  • Phone: 307-765-4700
  • Fax:
Mailing address:
  • Phone: 307-856-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number2698 WY PHARMACY
License Number StateWY

VIII. Authorized Official

Name: KATHERINE DIANE BOCHE
Title or Position: PHARMACIST
Credential: RPH
Phone: 307-856-7711