Provider Demographics
NPI:1477591592
Name:VANDEL, JOHN HASTINGS (R PH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HASTINGS
Last Name:VANDEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2708
Mailing Address - Country:US
Mailing Address - Phone:307-766-6120
Mailing Address - Fax:307-766-2953
Practice Address - Street 1:2041 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2708
Practice Address - Country:US
Practice Address - Phone:307-766-6120
Practice Address - Fax:307-766-2953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1435OtherPHARMACY LICENSE