Provider Demographics
NPI:1083606420
Name:A. E. ROEDEL DRUG INC
Entity Type:Organization
Organization Name:A. E. ROEDEL DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHARMACY TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:CHPT
Authorized Official - Phone:304-634-1571
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-0327
Mailing Address - Country:US
Mailing Address - Phone:307-634-1571
Mailing Address - Fax:
Practice Address - Street 1:2015 CAREY AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3622
Practice Address - Country:US
Practice Address - Phone:307-634-1571
Practice Address - Fax:307-634-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5200275333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0220360001Medicare ID - Type Unspecified