=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851997076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPTON PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2020
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 PINE ST.
-----------------------------------------------------
City | UPTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-746-3775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1124 WASHINGTON BLVD
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82701-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | TAVIS WEIDENBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-746-3742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------