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General NPI Number Information
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NPI Number | 1154661320
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Entity Type | Organization
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Legal Business Name | WYOMING MEDICATION DONATION PROGRAM
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 2508 E FOX FARM RD STE 2A
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City | CHEYENNE
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State | WY
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Zip | 82007-2559
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Country | US
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Telephone | 307-635-1297
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Fax | 307-635-2156
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Provider Business Mailing Address
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Address Line | 2300 CAPITOL AVE STE B-27
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City | CHEYENNE
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State | WY
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Zip | 82001-3672
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Country | US
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Telephone | 307-635-1297
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Fax | 307-635-2156
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Authorized Official
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Title or Position | PHARM.D., PIC, PROGRAM MANAGER
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Name | NATASHA GALLIZZI
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Credential |
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Telephone | 307-635-1297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | R10065
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License Number State | WY
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