Healthcare Provider Details

I. General information

NPI: 1730291659
Provider Name (Legal Business Name): RICKER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BIG HORN AVE
WORLAND WY
82401-2912
US

IV. Provider business mailing address

PO BOX 11
WORLAND WY
82401-0011
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-2281
  • Fax: 307-347-3736
Mailing address:
  • Phone: 307-347-2281
  • Fax: 307-347-3736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberR10027
License Number StateWY

VIII. Authorized Official

Name: JEFF YULE
Title or Position: OWNER
Credential:
Phone: 307-347-2281