Healthcare Provider Details

I. General information

NPI: 1851997076
Provider Name (Legal Business Name): UPTON PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PINE ST.
UPTON WY
82730
US

IV. Provider business mailing address

1124 WASHINGTON BLVD
NEWCASTLE WY
82701-2972
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-3775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAVIS WEIDENBACH
Title or Position: PHARMACY MANAGER
Credential:
Phone: 307-746-3742