Provider Demographics
NPI:1083743959
Name:SOMERS, WESLEY RICK (RPH)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:RICK
Last Name:SOMERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 DELL RIO DR
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-4207
Mailing Address - Country:US
Mailing Address - Phone:307-877-9458
Mailing Address - Fax:
Practice Address - Street 1:620 PINE AVE
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3002
Practice Address - Country:US
Practice Address - Phone:307-877-4209
Practice Address - Fax:307-877-6254
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist