=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457802480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANIMAL HEALTH INTERNATIONAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2016
-----------------------------------------------------
Last Update Date | 03/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 CORNERSTONE DR
-----------------------------------------------------
City | MOUNT JOY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17552-9419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-347-3498
-----------------------------------------------------
Fax | 717-653-3061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2915 ROCKY MOUNTAIN AVE STE 400
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-854-7664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR DIRECTORY PHARMACY OPS
-----------------------------------------------------
Name | DR. JEFFREY DAVID WIGFIELD
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 612-306-2721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PP482544
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------