Provider Demographics
NPI:1326133745
Name:CITY DRUG INC
Entity Type:Organization
Organization Name:CITY DRUG INC
Other - Org Name:CITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-760-5266
Mailing Address - Street 1:2775 W 6500 S
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-6729
Mailing Address - Country:US
Mailing Address - Phone:307-789-4000
Mailing Address - Fax:307-444-4000
Practice Address - Street 1:131 10TH ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3421
Practice Address - Country:US
Practice Address - Phone:307-789-4000
Practice Address - Fax:307-444-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYR100683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131468OtherPK
WY106098800Medicaid