Provider Demographics
NPI:1033123989
Name:THE DRUG STORE INC.
Entity Type:Organization
Organization Name:THE DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-787-6756
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:106 S. MAIN ST.
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937
Mailing Address - Country:US
Mailing Address - Phone:307-787-6756
Mailing Address - Fax:307-787-3792
Practice Address - Street 1:106 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-787-6756
Practice Address - Fax:307-787-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1731183500000X
WY52024073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5202407OtherNABP NUMBER