1972717577 NPI number — DAVE'S DRUG PARTNERSHIP

Table of content: (NPI 1972717577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972717577 NPI number — DAVE'S DRUG PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVE'S DRUG PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAVE'S HOME OXYGEN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972717577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1452 JOHNSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEATLAND
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82201-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-322-3425
Provider Business Mailing Address Fax Number:
307-322-3719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1452 JOHNSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATLAND
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82201-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-322-3425
Provider Business Practice Location Address Fax Number:
307-322-3719
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PARTNER PHARMACIST IN CHARGE
Authorized Official Telephone Number:
307-322-3425

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  R10004 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: R10004 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1066200-01 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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