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General NPI Number Information
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NPI Number | 1649382565
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Entity Type | Organization
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Legal Business Name | VICKLUND INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 610 S 6TH ST
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City | THERMOPOLIS
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State | WY
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Zip | 82443-3202
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Country | US
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Telephone | 307-864-2369
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Fax | 307-864-9202
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Provider Business Mailing Address
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Address Line | 610 S 6TH ST
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City | THERMOPOLIS
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State | WY
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Zip | 82443-3202
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Country | US
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Telephone | 307-864-2369
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Fax | 307-864-9202
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY JOSEPH DEROMEDI
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Credential |
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Telephone | 307-760-5192
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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 | R10114
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License Number State | WY
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