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General NPI Number Information
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NPI Number | 1871594895
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Entity Type | Organization
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Legal Business Name | SHATTO DRUG INC
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1202 E RICHARDS ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2934
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Country | US
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Telephone | 307-358-5077
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Fax | 307-358-6301
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Provider Business Mailing Address
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Address Line | PO BOX 705
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City | DOUGLAS
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State | WY
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Zip | 82633-0705
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Country | US
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Telephone | 307-358-5077
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Fax | 307-358-6301
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. TANNER B SHATTO
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Credential |
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Telephone | 307-358-5077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1995
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License Number State | WY
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