MEDICARE: WIND RIVER FAMILY AND COMMUNITY HEALTH PHARMACY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0002X	Clinic Pharmacy
5	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157957	OTHER		PK

General Provider Information

NPI Number	:	1528424611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIND RIVER FAMILY AND COMMUNITY HEALTH PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 1310
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-0158
Country	:	US
Telephone Number	:	307-857-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 GREAT PLAINS RD
Second Line	:
City	:	ARAPAHO
State	:	WY
Zip	:	82510
Country	:	US
Telephone Number	:	307-857-9491
Fax Number	:	307-856-9403

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	BRIAN OLAND
Credential	:
Telephone Number	:	307-857-9490

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/31/2020

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