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General NPI Number Information
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NPI Number | 1104965003
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Entity Type | Organization
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Legal Business Name | POWELL VALLEY HEALTH CARE, INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-1125
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Fax | 307-754-1176
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Provider Business Mailing Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-1125
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Fax | 307-754-1176
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Authorized Official
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Title or Position | CEO
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Name | MS. TERRY ODOM
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Credential | CEO
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Telephone | 307-754-1179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5201342
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 5201342
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License Number State | WY
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