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General NPI Number Information
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NPI Number | 1568640928
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Entity Type | Organization
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Legal Business Name | EMISSARY PROFESSIONAL GROUP
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 2546 E 2ND ST BLDG 100
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City | CASPER
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State | WY
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Zip | 82609-2062
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Country | US
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Telephone | 307-237-7751
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Fax | 307-237-7448
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Provider Business Mailing Address
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Address Line | 2546 E 2ND ST BLDG 100
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City | CASPER
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State | WY
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Zip | 82609-2062
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Country | US
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Telephone | 307-237-7751
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Fax | 307-237-7448
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY RENZ
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Credential | RPH
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Telephone | 307-472-0597
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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 | 52-03586
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License Number State | WY
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