MEDICARE: ROCK SPRINGS I.V. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336933134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK SPRINGS I.V. INC.

Provider Business Mailing Address
First Line	:	400 2ND ST STE A-1
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6260
Country	:	US
Telephone Number	:	307-382-3544
Fax Number	:	307-382-0987

Provider Business Practice Location Address
First Line	:	400 2ND ST STE A-1
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6260
Country	:	US
Telephone Number	:	307-382-3544
Fax Number	:	307-382-0987

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE OWNER
Name	:	MR. GARY PEDRI
Credential	:	R.PH.
Telephone Number	:	307-382-3544

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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