MEDICARE: STONE DRUG

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	333600000X	Pharmacy	PENDING	WY

General Provider Information

NPI Number	:	1356664239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE DRUG

Provider Business Mailing Address
First Line	:	PO BOX 9000
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-9000
Country	:	US
Telephone Number	:	307-733-9768
Fax Number	:	307-733-3528

Provider Business Practice Location Address
First Line	:	830 W BROADWAY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-9000
Country	:	US
Telephone Number	:	307-733-9768
Fax Number	:	307-733-9768

Authorized Official
Title or Position	:	OWNER TREASURER
Name	:	SARAH R BALBEN
Credential	:	RPH,PIC OWNER
Telephone Number	:	307-733-9768

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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Directions to “STONE DRUG ” Practice Location

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