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General NPI Number Information
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NPI Number | 1982027876
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Entity Type | Organization
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Legal Business Name | CDE LLC
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 131 10TH ST
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City | EVANSTON
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State | WY
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Zip | 82930-3421
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Country | US
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Telephone | 307-789-4000
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Fax | 307-444-4000
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Provider Business Mailing Address
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Address Line | 131 10TH ST
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City | EVANSTON
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State | WY
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Zip | 82930-3421
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Country | US
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Telephone | 307-789-4000
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Fax | 307-444-4000
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREW CANNON
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Credential |
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Telephone | 307-789-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | R10068
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License Number State | WY
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