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General NPI Number Information
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NPI Number | 1346343498
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Entity Type | Organization
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Legal Business Name | STAR VALLEY DRUG CO
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 190 N MAIN
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City | THAYNE
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State | WY
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Zip | 83127-1006
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Country | US
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Telephone | 307-883-4600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1006 190 N MAIN
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City | THAYNE
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State | WY
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Zip | 83127-1006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL STAUFFER
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Credential |
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Telephone | 307-885-9804
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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 | 5203031
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 |
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License Number State |
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