Provider Demographics
NPI:1407859911
Name:DEER CREEK DRUG
Entity Type:Organization
Organization Name:DEER CREEK DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-436-9611
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-0940
Mailing Address - Country:US
Mailing Address - Phone:307-436-9611
Mailing Address - Fax:307-436-8933
Practice Address - Street 1:215 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637-0940
Practice Address - Country:US
Practice Address - Phone:307-436-9611
Practice Address - Fax:307-436-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5202471333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1246220001Medicare ID - Type Unspecified