Provider Demographics
NPI:1275742009
Name:K. DIANE BOCHE
Entity Type:Organization
Organization Name:K. DIANE BOCHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-856-7711
Mailing Address - Street 1:1625 N SMITH RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-9436
Mailing Address - Country:US
Mailing Address - Phone:307-856-7711
Mailing Address - Fax:
Practice Address - Street 1:513 GREYBULL AVE
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2038
Practice Address - Country:US
Practice Address - Phone:307-765-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2698 WY PHARMACY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare