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General NPI Number Information
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NPI Number | 1316087299
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY, INC.
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 101 CONSTITUTION AVE.
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City | SARATOGA
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State | WY
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Zip | 82331
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Country | US
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Telephone | 307-326-5129
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Fax | 307-326-5165
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Provider Business Mailing Address
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Address Line | PO BOX 683
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City | SARATOGA
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State | WY
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Zip | 82331-0683
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Country | US
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Telephone |
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Fax | 307-326-5165
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Authorized Official
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Title or Position | OWNER/RPH
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Name | ROD WAECKERLIN
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Credential |
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Telephone | 307-320-8482
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 52-03120
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License Number State | WY
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