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General NPI Number Information
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NPI Number | 1992101307
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Entity Type | Organization
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Legal Business Name | WYOMING PHARMACIES LLC
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 443 SPRING ST SUITE 303
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4494
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Country | US
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Telephone | 812-590-2355
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Fax | 812-590-3355
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Provider Business Mailing Address
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Address Line | 443 SPRING ST SUITE 303
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4494
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Country | US
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Telephone | 812-590-2355
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Fax | 812-590-3355
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. ASSAD T NASR
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Credential |
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Telephone | 812-590-2355
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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 |
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License Number State |
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