Provider Demographics
NPI:1073618385
Name:SPERRY ENTERPRISES INC.
Entity Type:Organization
Organization Name:SPERRY ENTERPRISES INC.
Other - Org Name:SPERRY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-334-3132
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:232 S. MAIN ST.
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0690
Mailing Address - Country:US
Mailing Address - Phone:307-334-3132
Mailing Address - Fax:307-334-2026
Practice Address - Street 1:232 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-0690
Practice Address - Country:US
Practice Address - Phone:307-334-3132
Practice Address - Fax:307-334-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52019003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1118960001Medicare ID - Type Unspecified