Provider Demographics
NPI:1437252582
Name:STAR VALLEY DRUG CO
Entity Type:Organization
Organization Name:STAR VALLEY DRUG CO
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-885-9804
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0099
Mailing Address - Country:US
Mailing Address - Phone:307-885-9804
Mailing Address - Fax:307-885-9760
Practice Address - Street 1:439 WASHINGTON
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0099
Practice Address - Country:US
Practice Address - Phone:307-885-9804
Practice Address - Fax:307-885-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5200059332B00000X
333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5200059OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WY0251250001Medicare NSC