Provider Demographics
NPI:1730291659
Name:RICKER DRUG INC
Entity Type:Organization
Organization Name:RICKER DRUG INC
Other - Org Name:RICKER PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:YULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-347-2281
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-0011
Mailing Address - Country:US
Mailing Address - Phone:307-347-2281
Mailing Address - Fax:307-347-3736
Practice Address - Street 1:1801 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2912
Practice Address - Country:US
Practice Address - Phone:307-347-2281
Practice Address - Fax:307-347-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
WYR100273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106164000Medicaid
2111172OtherPK
1156440001Medicare NSC