Provider Demographics
NPI:1346332970
Name:ROCK SPRINGS I.V. INC.
Entity Type:Organization
Organization Name:ROCK SPRINGS I.V. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:PEDRI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-382-3544
Mailing Address - Street 1:400 2ND ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6260
Mailing Address - Country:US
Mailing Address - Phone:307-382-3544
Mailing Address - Fax:307-382-0987
Practice Address - Street 1:400 2ND ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6260
Practice Address - Country:US
Practice Address - Phone:307-382-3544
Practice Address - Fax:307-382-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WY52-031563336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113201601Medicaid
ID807308Medicaid
WY113201601Medicaid
ID807308Medicaid