Healthcare Provider Details

I. General information

NPI: 1972717577
Provider Name (Legal Business Name): DAVE'S DRUG PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 JOHNSTON ST
WHEATLAND WY
82201-3232
US

IV. Provider business mailing address

1452 JOHNSTON ST
WHEATLAND WY
82201-3232
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-3425
  • Fax: 307-322-3719
Mailing address:
  • Phone: 307-322-3425
  • Fax: 307-322-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberR10004
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberR10004
License Number StateWY

VIII. Authorized Official

Name: DAVID MICHAEL BURKE
Title or Position: PARTNER PHARMACIST IN CHARGE
Credential: RPH
Phone: 307-322-3425