Provider Demographics
NPI:1285835553
Name:LAYA'S MAIN STREET PHARMACY
Entity Type:Organization
Organization Name:LAYA'S MAIN STREET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPHT
Authorized Official - Prefix:
Authorized Official - First Name:SUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-3741
Mailing Address - Street 1:555 N MAIN ST
Mailing Address - Street 2:P.O. BOX 6283
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3630
Mailing Address - Country:US
Mailing Address - Phone:307-672-3741
Mailing Address - Fax:
Practice Address - Street 1:555 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3630
Practice Address - Country:US
Practice Address - Phone:307-672-3741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5282801332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies