Provider Demographics
NPI:1164812475
Name:WESTON COUNTY PHARMACY
Entity Type:Organization
Organization Name:WESTON COUNTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-746-2425
Mailing Address - Street 1:1124 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2972
Mailing Address - Country:US
Mailing Address - Phone:307-746-2425
Mailing Address - Fax:
Practice Address - Street 1:727A WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701
Practice Address - Country:US
Practice Address - Phone:307-746-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTON COUNTY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYR10140183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty