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General NPI Number Information
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NPI Number | 1033123989
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Entity Type | Organization
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Legal Business Name | THE DRUG STORE INC.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 106 S. MAIN ST.
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City | LYMAN
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State | WY
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Zip | 82937
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Country | US
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Telephone | 307-787-6756
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Fax | 307-787-3792
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Provider Business Mailing Address
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Address Line | PO BOX 1700 106 S. MAIN ST.
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City | LYMAN
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State | WY
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Zip | 82937
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Country | US
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Telephone | 307-787-6756
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Fax | 307-787-3792
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT B. AVERY
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Credential | RPH
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Telephone | 307-787-6756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5202407
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1731
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License Number State | WY
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